Infecções em pós-craniotomias: revisão literária / Infections in post craniotomies: literary review

Este artigo tem o objetivo de alertar e informar sobre as principais infecções do sistema nervoso central pós-procedimento da craniotomia, revisando dados epidemiológicos, profiláticos, fatores de risco, tratamento e outros pontos relevantes da infecção de ferida operatória, de meningite e de abscesso cerebral. Averígua-se a importância dos cuidados de assepsia com a lavagem do sítio cirúrgico com antisséptico degermante seguido de solução antisséptica alcoólica com princípio ativo (PVPI ou clorexidina), da equipe cirúrgica na degermação das mãos e paramentação e com os instrumentais e sala cirúrgica. Além disso, é discutido o valor da realização ou não da tricotomia, já que esta não mostra diferenças relativas nas incidências em acometimentos de patógenos. É de conclusão principal que, mesmo com as baixas incidências dessas infecções pós-craniotomias, estudos mais abrangentes e informativos sobre o assunto devem ser realizados em todo o mundo, por causa da gravidade do quadro clínico, seus prognósticos ruins, tratamentos intensivos, envolvimento de equipes multiprofissionais, extensão dos dias de internação, estadia em unidade de terapia intensiva e alta morbimortalidade.

In order to alert and inform about the main central nervous system infections after craniotomy procedure. Reviewing epidemiological, prophylactic, risk factors, treatment and other relevant points of wound infection, meningitis and brain abscess. Ascertains the importance of aseptic precautions by washing the surgical site with an antiseptic detergent followed by alcoholic antiseptic solution with active ingredient (chlorhexidine or PVPI), the surgical team in the antisepsis of hands and scrub and surgical instruments and operating room. Furthermore, it is discussed and whether or not the value of hair removal, since it does not show an effect on relative differences in affections of pathogens. It is the main conclusion that even with the low incidence of these infections after craniotomy, the most comprehensive and informative studies on the subject should be conducted around the world, due to the severity of clinical symptoms, their prognosis poor, intensive care, involvement of multidisciplinary teams, length of hospital stay, stay in the intensive care unit, a high mortality.

Brain Abscess at the University Hospital of the West Indies

Surgical infections of the central nervous system are still attended by high rates of morbidity and mortality, although substantial progress has been made since the advent of computed tomography (CT) scanning technology. In this retrospective review of 25 surgically treated patients with either brain abscess of subdural empyema at the University Hospital of the West Indies, the majority of patients were male and between the ages of 10 and 30 years with a mean age of 16.9 years. Almost half the patients had a hemiparesis on presentation while 60 percent had fever. Subdural empyema was more common than a localised intracerebral abscess which was most frequently located in the frontal lobe. The most common predisposing factors were sinusitis and congenital heart disease. Streptococci spp and Staphylococci spp were the most frequently isolated organisms. All patients underwent CT scanning and surgical intervention. The mortality rate was 20 percent, and 21 percent of the survivors had late seizures. There must be a high index of clinical suspicion and early referral to specialist centres where neuroradiological investigation and prompt neurosurgical intervention can be carried out to minimise morbidity and mortality.

Patología infecciosa pseudotumoral del sistema nervioso central en la infancia / Infections mimicking central nervous system (CNS) tumors in children

Las infecciones del sistema nervioso central(SNC)pueden presentarse como lesiones ocupantes seudotumorales con efecto de masa,principalmente en pacientes inmunosuprimidos,pudiendo ser la primera manifestación de la enfermedad.La mayoría de los casos publicados corresponden a adultos especialmente dentro de la población HIV.En un contexto clínico adecuado,lesiones de tipo tumoral en las neuroimágenes,deben plantear el diagnóstico diferencial con patología infecciosa.Nuestro objetivo es describir los hallazgos clínicos y de neuroimágenes de 16 pacientes con infecciones intracraneanas a forma seudotumoral que requieren cirugía con presunción diagnóstica de lesión neoplásica.En nuestra serie de 1.0005 lesiones expansivas intracraneales neuroquirúrgicas,excluyendo inmunosuprimidos,trasplantados y HIV conocidos(con riesgo potencial de absceso cerebral)se diagnosticaron en 16 biopsias cerebrales(1,6 por ciento)Infecciones por protozoarios(enfermedad de Chagas:2,toxoplasmosis:3,uno de ellos asociado a Mycobacterium avium intracellulare,amebas de via libre:2)cestodes(Cysticercus cellulosae:2,quiste hidiatídico Echinococcus granulosus:4 y tuberculomas:3.En casos clínicos estudiados y seleccionados algunas observaciones pueden ayudar a evitar procedimientos invasivos del SNC así como modificar la táctica y técnica quirúrgica