Abridor de Cabeça (Livro Escrito em Letra de Médico)

Abridor de Cabeça (Livro Escrito em Letra de Médico)

Neurosurgery Blog

Abridor de Cabeça 

Autor: Julio Pereira

No início tudo me parecia novo. Não conhecia ao certo o dia a dia da minha escolha. Só me lembro dos conselhos de minha avó, que dizia para fazer algo que pouca gente fazia. Com essa frase, fiz minhas escolhas. E vou ser sincero: sou bom em fazer provas, gosto de estudar e de aceitar desafios.

A senhora tem um tumor cerebral.
E isso é grave, Dr.?
É, mas podemos operar e tirar.
Abrir a cabeça?
É.
Posso morrer?
Pode.
Tem outro jeito?
Não.
E se não operar?
Pode morrer com ele crescendo.
Mas vocês fazem isso sempre?
Todo dia.

Os diálogos eram sempre muito iguais. Acho que na verdade todas as pessoas leem o laudo e procuram na internet. Mas realmente abrir a cabeça não parece uma boa ideia. Tenho a impressão de que existem coisas que não devem ser feitas.

Não tem como tomar um remédio?
Não.

O problema é que criamos soluções humanas demais. Na literatura, as soluções são mais mágicas e com um significado maior. Abrir a cabeça? Cortar a pele até encontrar o osso e depois retirá-lo. Sempre colocamos o osso no soro. Depois abrimos as meninges. Procuramos o tumor e retiramos. Tudo isso com sangue e emoção. Humano demais. Na verdade, nas primeiras vezes, um pouco mais de emoção, depois acostumamos.

O senhor já fez alguma cirurgia dessa?
Já.
Dá certo?
A maioria.
Posso ficar paralisada na cama?
Pode.

As pessoas deveriam ter direito a uma realidade única, diferente. Cada um teria uma doença única, só dela.

Por que as pessoas têm essa doença?
Não sabemos, são várias causas.
É genética?
Também.

Esse na verdade é a etapa que menos gosto: Os porquês. Na verdade só sei o que tem e o que fazer. Até teria vontade de conversar sobre o existencialismo, mas não seria oportuno.
A senhora faz esses exames e vamos marcar a cirurgia.
Vai ser aqui mesmo?
Isso.
Fico quantos dias depois da cirurgia?
Se tudo der certo, de 5 a 10 dias.
E se não der?
Não se preocupe, espero que tudo dê certo.

Livro: Escrito em Letra de Médico. ( Texto: Abridor de cabeça)

 

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Original Article: http://neurocirurgiabr.com/abridor-de-cabeca-livro-escrito-em-letra-de-medico/?utm_source=rss&utm_medium=rss&utm_campaign=abridor-de-cabeca-livro-escrito-em-letra-de-medico

Julio Pereira, MD

Linkedin:http://www.linkedin.com/in/juliommais 

Site: www.neurocirurgiabr.com

Half of patients in Cedars-Sinai glioblastoma study still alive after 5 years

Half of patients in Cedars-Sinai glioblastoma study still alive after 5 years

Neurology News & Neuroscience News from Medical News Today

Eight of 16 patients participating in a study of an experimental immune system therapy directed against the most aggressive malignant brain tumors - glioblastoma multiforme - survived longer than five years after diagnosis, according to Cedars-Sinai researchers, who presented findings at the Fourth Quadrennial Meeting of the World Federation of Neuro-Oncology.

Original Article: http://www.medicalnewstoday.com/releases/269276.php

Julio Pereira, MD

Linkedin:http://www.linkedin.com/in/juliommais 

Site: www.neurocirurgiabr.com

Is There Pseudoprogression in Secondary Glioblastomas?

Is There Pseudoprogression in Secondary Glioblastomas?

International Journal of Radiation Oncology * Biology * Physics

Purpose: Pseudoprogression (PP) during adjuvant treatment of glioblastoma (GBM) is frequent and is a clinically and radiologically challenging problem. While there are several reports of the frequency of PP in GBM cohorts including mainly patients with primary GBM, there are few data on the incidence of PP in patients with secondary glioblastomas (sGBM). Therefore, the goal of this study was to evaluate the frequency of PP in sGBM.Methods and Materials: We retrospectively evaluated the incidence of PP in adult patients with sGBM treated with chemoradiation therapy (CRTx) using temozolomide (TMZ) and sought to assess if there was an association between PP and MGMT promoter methylation status, IDH mutations status, or 1p/19q codeletion. The definition of PP according to the Response Assessment in Neuro-Oncology Working Group was used.Results: None of the evaluable 15 sGBM patients in our series demonstrated a PP. Of the 9 sGBM patients who received concomitant CRTx with TMZ, 6 patients had the methylated MGMT promoter, and 6 patients had IDH mutations. There also was no PP identified in sGBM patients who received sequential CRTx, irrespective of MGMT or IDH status. The median time of follow-up was 3.4 years after diagnosis of an sGBM, and the median overall survival was 18.2 months (range, 14.3-45.2 months). Three of 15 patients had previously received radiation therapy for their World Health Organization low-grade 2 glioma, while none of them had received chemotherapy at that stage.Conclusions: Based on this small series of sGBM patients treated with CRTx (concomitantly or sequentially) the frequency of PP appears to be very low in sGBM, even in those patients with methylated MGMT promoter or IDH mutations. Our results highlight the differences between primary glioblastomas and sGBM in particular as they relate to PP.

Original Article: http://www.redjournal.org/article/S0360-3016(13)03144-1/abstract?rss=yes

Julio Pereira, MD

Linkedin:http://www.linkedin.com/in/juliommais 

Site: www.neurocirurgiabr.com

Access to Neuropsychologic Services After Pediatric Brain Tumor

Access to Neuropsychologic Services After Pediatric Brain Tumor

Pediatric Neurology

Abstract: Background: Increasing survival rates for children with brain tumors creates a greater need for neuropsychologic follow-up and intervention. The aim of this study was to evaluate rates of referral by medical doctors to neuropsychologic services and patient and treatment factors that differentiated referred and nonreferred patients.Methods: Data were retrieved from medical records of all pediatric brain tumor patients in southern Sweden diagnosed between 1993 and 2004 who survived more than 1 year (n = 132). Characteristics of the patients, the cancer, and treatment received were then compared for patients who were and were not referred for neuropsychologic examination during that period.Results: Sixty-four (48%) of the pediatric brain tumor patients were referred for neuropsychologic evaluation. These patients had significantly larger tumors, more recurrences of cancer, and increased intracranial pressure at diagnosis when compared with the nonreferred group (n = 68). However, most of the patients in the nonreferred group either had significant risk factors for cognitive impairment or were reporting impairments that would suggest a referral was warranted.Conclusions: Given the high rates of cognitive impairment in children with brain tumors, referral to neuropsychologic services should be considered in all survivors. In addition to improving long-term adjustment, systematic referral can provide data on cognitive impairments, making it possible to evaluate different cancer treatment protocols not only in terms of survival but also in terms of quality of survival. Greater efforts are needed to disseminate and raise awareness about published guidelines on the long-term care of pediatric brain tumor patients.

Original Article: http://www.pedneur.com/article/S0887-8994(13)00412-8/abstract?rss=yes

Julio Pereira, MD

Linkedin:http://www.linkedin.com/in/juliommais 

Site: www.neurocirurgiabr.com

Magnetic Resonance Imaging-Guided Focused Laser Interstitial Thermal Therapy for Intracranial Lesions: Single-Institution Series

Magnetic Resonance Imaging-Guided Focused Laser Interstitial Thermal Therapy for Intracranial Lesions: Single-Institution Series

Neurosurgery - Current Issue

BACKGROUND:Surgical treatments for deep-seated intracranial lesions have been limited by morbidities associated with resection. Real-time magnetic resonance imaging–guided focused laser interstitial thermal therapy (LITT) offers a minimally invasive surgical treatment option for such lesions. OBJECTIVE:To review treatments and results of patients treated with LITT for intracranial lesions at Washington University School of Medicine. METHODS:In a review of 17 prospectively recruited LITT patients (34-78 years of age; mean, 59 years), we report demographics, treatment details, postoperative imaging characteristics, and peri- and postoperative clinical courses. RESULTS:Targets included 11 gliomas, 5 brain metastases, and 1 epilepsy focus. Lesions were lobar (n = 8), thalamic/basal ganglia (n = 5), insular (n = 3), and corpus callosum (n = 1). Mean target volume was 11.6 cm3, and LITT produced 93% target ablation. Patients with superficial lesions had shorter intensive care unit stays. Ten patients experienced no perioperative morbidities. Morbidities included transient aphasia, hemiparesis, hyponatremia, deep venous thrombosis, and fatal meningitis. Postoperative magnetic resonance imaging showed blood products within the lesion surrounded by new thin uniform rim of contrast enhancement and diffusion restriction. In conjunction with other therapies, LITT targets often showed stable or reduced local disease. Epilepsy focus LITT produced seizure freedom at 8 months. Preliminary overall median progression-free survival and survival from LITT in tumor patients were 7.6 and 10.9 months, respectively. However, this small cohort has not been followed for a sufficient length of time, necessitating future outcomes studies. CONCLUSION:Early peri- and postoperative clinical data demonstrate that LITT is a safe and viable ablative treatment option for intracranial lesions, and may be considered for select patients. ABBREVIATION:LITT, laser interstitial thermal therapy

Original Article: http://journals.lww.com/neurosurgery/Fulltext/2013/12000/Magnetic_Resonance_Imaging_Guided_Focused_Laser.20.aspx

Julio Pereira, MD

Linkedin:http://www.linkedin.com/in/juliommais 

Site: www.neurocirurgiabr.com

Predicting Tumor Control After Resection Bed Radiosurgery of Brain Metastases

Predicting Tumor Control After Resection Bed Radiosurgery of Brain Metastases

Neurosurgery - Current Issue

BACKGROUND:Stereotactic radiosurgery (SRS) to the resection bed of a brain metastasis is an important treatment option. OBJECTIVE:To identify factors associated with tumor progression after SRS of the resection bed of a brain metastasis and to evaluate patterns of failure for patients who eventually had tumor progression. METHODS:We performed a retrospective analysis of 120 patients who underwent tumor bed radiosurgery after an initial gross total resection. The mean imaging follow-up time was 55 weeks. The median margin dose was 16 Gy. Forty-seven patients (39.2%) underwent whole-brain radiation therapy before or shortly after SRS. RESULTS:Local tumor control was achieved in 103 patients (85.8%). Progression-free survival was 96% at 6 months, 87% at 12 months, and 74% at 24 months. Recurrence most commonly occurred deep in the cavity (65%) outside the planned treatment volume (PTV) margin (53%). PTV, cavity diameter, and a margin dose < 16 Gy significantly correlated with local failure. For patients with PTVs ≥ 8.0 cm3, local progression-free survival declined to 93% at 6 months, 83% at 12 months, and 65% at 24 months. Development or progression of distant metastases occurred in 40% of patients. Whole-brain radiation therapy was not associated with improved local control. CONCLUSION:Resection bed SRS for brain metastases provided excellent local control. The cavity PTV is predictive of tumor control. Because failure usually occurs outside the PTV, inclusion of a judicious 2- to 3-mm margin beyond the area of postoperative enhancement may be prudent. ABBREVIATIONS:ARE, adverse radiation effectPTV, planned treatment volumeSRS, stereotactic radiosurgeryWBRT, whole-brain radiation therapy

Original Article: http://journals.lww.com/neurosurgery/Fulltext/2013/12000/Predicting_Tumor_Control_After_Resection_Bed.19.aspx

Julio Pereira, MD

Linkedin:http://www.linkedin.com/in/juliommais 

Site: www.neurocirurgiabr.com

American Society for Radiation Oncology (ASTRO) 2012 Workforce Study: The Radiation Oncologists' and Residents' Perspectives

American Society for Radiation Oncology (ASTRO) 2012 Workforce Study: The Radiation Oncologists' and Residents' Perspectives

International Journal of Radiation Oncology * Biology * Physics

Purpose: The American Society for Radiation Oncology (ASTRO) conducted the 2012 Radiation Oncology Workforce Survey to obtain an up-to-date picture of the workforce, assess its needs and concerns, and identify quality and safety improvement opportunities. The results pertaining to radiation oncologists (ROs) and residents (RORs) are presented here.Methods: The ASTRO Workforce Subcommittee, in collaboration with allied radiation oncology professional societies, conducted a survey study in early 2012. An online survey questionnaire was sent to all segments of the radiation oncology workforce. Respondents who were actively working were included in the analysis. This manuscript describes the data for ROs and RORs.Results: A total of 3618 ROs and 568 RORs were surveyed. The response rate for both groups was 29%, with 1047 RO and 165 ROR responses. Among ROs, the 2 most common racial groups were white (80%) and Asian (15%), and the male-to-female ratio was 2.85 (74% male). The median age of ROs was 51. ROs averaged 253.4 new patient consults in a year and 22.9 on-treatment patients. More than 86% of ROs reported being satisfied or very satisfied overall with their career. Close to half of ROs reported having burnout feelings. There was a trend toward more frequent burnout feelings with increasing numbers of new patient consults. ROs' top concerns were related to documentation, reimbursement, and patients' health insurance coverage. Ninety-five percent of ROs felt confident when implementing new technology. Fifty-one percent of ROs thought that the supply of ROs was balanced with demand, and 33% perceived an oversupply.Conclusions: This study provides a current snapshot of the 2012 radiation oncology physician workforce. There was a predominance of whites and men. Job satisfaction level was high. However a substantial fraction of ROs reported burnout feelings. Perceptions about supply and demand balance were mixed. ROs top concerns reflect areas of attention for the healthcare sector as a whole.

Original Article: http://www.redjournal.org/article/S0360-3016(13)03073-3/abstract?rss=yes

Julio Pereira, MD

Linkedin:http://www.linkedin.com/in/juliommais 

Site: www.neurocirurgiabr.com

Subependymal Giant Cell Astrocytoma: Diagnosis, Screening, and Treatment. Recommendations From the International Tuberous Sclerosis Complex Consensus Conference 2012

Subependymal Giant Cell Astrocytoma: Diagnosis, Screening, and Treatment. Recommendations From the International Tuberous Sclerosis Complex Consensus Conference 2012

Pediatric Neurology

Abstract: Background: Tuberous sclerosis complex is an autosomal dominant disorder predisposing to the development of benign lesions in different body organs, mainly in the brain, kidney, liver, skin, heart, and lung. Subependymal giant cell astrocytomas are characteristic brain tumors that occur in 10% to 20% of tuberous sclerosis complex patients and are almost exclusively related to tuberous sclerosis complex. Subependymal giant cell astrocytomas usually grow slowly, but their progression ultimately leads to the occlusion of the foramen of Monro, with subsequent increased intracranial pressure and hydrocephalus, thus necessitating intervention. During recent years, secondary to improved understanding in the biological and genetic basis of tuberous sclerosis complex, mammalian target of rapamycin inhibitors have been shown to be effective in the treatment of subependymal giant cell astrocytomas, becoming an alternative therapeutic option to surgery.Methods: In June 2012, an International Tuberous Sclerosis Complex Consensus Conference was convened, during which an expert panel revised the diagnostic criteria and considered treatment options for subependymal giant cell astrocytomas. This article summarizes the subpanel's recommendations regarding subependymal giant cell astrocytomas.Conclusions: Mammalian target of rapamycin inhibitors have been shown to be an effective treatment of various aspects of tuberous sclerosis complex, including subependymal giant cell astrocytomas. Both mammalian target of rapamycin inhibitors and surgery have a role in the treatment of subependymal giant cell astrocytomas. Various subependymal giant cell astrocytoma–related conditions favor a certain treatment.

Original Article: http://www.pedneur.com/article/S0887-8994(13)00542-0/abstract?rss=yes

Julio Pereira, MD

Linkedin:http://www.linkedin.com/in/juliommais 

Site: www.neurocirurgiabr.com

Neurocognitive assessment following whole brain radiation therapy and radiosurgery for patients with cerebral metastases

Neurocognitive assessment following whole brain radiation therapy and radiosurgery for patients with cerebral metastases

Journal of Neurology, Neurosurgery & Psychiatry current issue

The treatment of metastatic brain lesions remains a central challenge in oncology. Because most chemotherapeutic agents do not effectively cross the blood–brain barrier, it is widely accepted that radiation remains the primary modality of treatment. The mode by which radiation should be delivered has, however, become a source of intense controversy in recent years. The controversy involves whether patients with a limited number of brain metastases should undergo whole brain radiation therapy (WBRT) or stereotactic radiosurgery (SRS) delivered only to the radiographically visible tumours. Survival is comparable for patients treated with either modality. Instead, the controversy involves the neurocognitive function (NCF) of radiating cerebrum that appeared radiographically normal relative to effects of the growth from micro-metastatic foci. A fundamental question in this debate involves quantifying the effect of WBRT in patients with cerebral metastasis. To disentangle the effects of WBRT on neurocognition from the effects inherent to the underlying disease, we analysed the results from randomised controlled studies of prophylactic cranial irradiation in oncology patients as well as studies where patients with limited cerebral metastasis were randomised to SRS versus SRS+WBRT. In aggregate, these results suggest deleterious effects of WBRT in select neurocognitive domains. However, there are insufficient data to resolve the controversy of upfront WBRT versus SRS in the management of patients with limited cerebral metastases.

Original Article: http://jnnp.bmj.com/cgi/content/short/84/12/1384?rss=1

Julio Pereira, MD

Linkedin:http://www.linkedin.com/in/juliommais 

Site: www.neurocirurgiabr.com

How neural circuits identify information needed for decisions

How neural circuits identify information needed for decisions

Neurology News & Neuroscience News from Medical News Today

While eating lunch you notice an insect buzzing around your plate. Its color and motion could both influence how you respond. If the insect was yellow and black you might decide it was a bee and move away. Conversely, you might simply be annoyed at the buzzing motion and shoo the insect away. You perceive both color and motion, and decide based on the circumstances...

Original Article: http://www.medicalnewstoday.com/releases/268516.php

Julio Pereira, MD

Linkedin:http://www.linkedin.com/in/juliommais 

Site: www.neurocirurgiabr.com