Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 1.085
Filter
1.
Rev. chil. neuropsicol. (En línea) ; 16(1): 28-36, ene. 2022.
Article in Spanish | LILACS | ID: biblio-1362112

ABSTRACT

La craneotomía con paciente despierto (CPD) demanda un manejo multidisciplinario particular debido al componente de conciencia transoperatoria que aporta beneficios en la resección tumoral y preservación neurológica, pero también implica el manejo de los riesgos asociados a la necesidad de cooperación del paciente durante el procedimiento. En este trabajo se describen los beneficios y las complicaciones en pacientes operados bajo la modalidad de CPD. Además, se abordan los retos documentados tanto para el equipo profesional a cargo, como para los pacientes, los cuales tienen un rol activo durante la cirugía. En ese sentido, se exponen los criterios para la selección, preparación psicológica y neuropsicológica tanto previo como durante la cirugía. A su vez, se proponen las consideraciones para lograr un procedimiento exitoso y evitar las posibles secuelas psicológicas a largo plazo, como insumos para la protocolización de este tipo de procedimientos con base en nuestra experiencia.


Awake craniotomy (AC) requires a multidisciplinary management due to trans operative awareness, which benefits the tumor resection and neurologic preservation, but it also implies risks for the patient cooperation during the procedure. This article describes the benefits and complications in patients operated under AC. Besides, it approaches the documented challenges for both the professional team and patients, who have an active role during surgery. In this regard, the criteria for selection and psychological and neuropsychological preparation before and during surgery are set out. It suggests considerations to achieve a successful procedure and to avoid possible long- term psychological sequelae, as a resource for the protocol of this type of procedures based on our experience.


Subject(s)
Humans , Wakefulness , Neurosurgical Procedures/methods , Craniotomy/methods , Postoperative Period , Patient Compliance , Conscience
2.
Rev. Pesqui. Fisioter ; 11(3): 569-582, ago.2021. ilus
Article in English, Portuguese | LILACS | ID: biblio-1292203

ABSTRACT

INTRODUÇÃO: A craniotomia torna mais fácil a compreensão e abordagem do cérebro, mas acompanha as doenças. As unidades de terapia intensiva são equipadas com fisioterapeutas profissionais treinados para lidar com esses efeitos deletérios após este programa cirúrgico, mas falta um protocolo progressivo, definido e apoiado por evidências para esses pacientes. OBJETIVO: Avaliar a viabilidade do protocolo de neuro-reabilitação elaborado para pacientes pós-craniotomia durante sua internação em Unidade de Terapia Intensiva (UTI) para melhorar seus resultados funcionais e reduzir seu tempo de internação (LOS). MATERIAIS E MÉTODOS: Será um ensaio de quase viabilidade pós-teste de pré-teste de grupo único. Quinze pacientes submetidos à craniotomia serão recrutados para o estudo e serão processados com protocolo de Neuro-reabilitação por 60 minutos do primeiro dia da cirurgia até o 15º dia da cirurgia. O resultado primário será a Escala de Habilidades Funcionais Precoces (EFA) para medição de resultados funcionais como nível de consciência, habilidades sensório-motoras, habilidades cognitivo-perceptuais e habilidades oromotoras de pacientes que serão avaliadas no primeiro dia após a craniotomia. Os resultados secundários incluirão Escala de Coma de Glasgow (GCS), Escala de Recuperação de Coma - Revisada (CRS-R), Técnica de Reabilitação de Avaliação de Modalidade Sensorial (SMART), Escala de Ashworth modificada modificada (mMAS), Pontuação de Avaliação Cognitiva de Montreal (MoCA) e Conselho de Pesquisa Médica Escala (MRC). As avaliações serão feitas no primeiro e no décimo quinto dia pós-operatório. PERSPECTIVAS: Espera-se que este protocolo melhore os resultados funcionais e reduza a incidência de ocorrência de comorbidades em pacientes após craniotomia em UTI.


INTRODUCTION: Craniotomy makes insight and approach towards the brain easier but accompanies ailments. Intensive care units are equipped with trained professional physical therapists working over these deleterious after-effects of this surgical program, but a progressive, defined, and evidence-supported protocol for such patients is lacking. OBJECTIVE: To assess the feasibility of a Neurorehabilitation protocol devised for post-craniotomy patients within their stay in the Intensive Care Unit (ICU) to improve their functional outcomes and reduce their length of stay (LOS). MATERIALS AND METHODS: It will be a single group pre-test post-test quasi feasibility trial. Fifteen patients undergoing craniotomy will be recruited for the trial and will be rendered with Neuro-rehabilitation protocol for 60 minutes from the first day of surgery up to 15 days of surgery. The primary outcome will be the Early Functional Abilities (EFA) Scale to measure functional outcomes like conscious level, sensorimotor abilities, cognitive-perceptual abilities, and oro-motor abilities of patients, which will be assessed first-day post craniotomy. Secondary outcomes will include Glasgow Coma Scale (GCS), Coma Recovery Scale-Revised (CRS-R), Sensory Modality Assessment Rehabilitation Technique (SMART), Modified Ashworth Scale (mMAS), Montreal Cognitive Assessment Score (MoCA), and Medical Research Council Scale (MRC). Assessments will be taken on the first and fifteenth days post-surgery. PERSPECTIVES: It is expected that this protocol might improve functional outcomes and may reduce the occurrence of comorbidities in patients after Craniotomy in ICUs.


Subject(s)
Craniotomy , Coma , Intensive Care Units
3.
Rev. cuba. anestesiol. reanim ; 20(1): e644, ene.-abr. 2021. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1156369

ABSTRACT

Introducción: La craneotomía con el paciente despierto es útil para lograr resecciones cerebrales amplias de lesiones de áreas elocuentes. Objetivo: Presentar un caso al que se le realizó la técnica dormido- despierto. Método: Se realizó la inducción de la anestesia con propofol/fentanilo/rocuronio y se colocó una mascarilla laríngea. Después del bloqueo de escalpe se mantuvo la infusión de propofol/fentanilo y lidocaína hasta que se realizó la craneotomía. Se disminuyó la velocidad de infusión y se mantuvo de esta manera hasta finalizada la intervención. Resultados: Se logró el despertar del paciente a los 13 minutos de reducida la infusión. Se mantuvo buena estabilidad hemodinámica, sin depresión respiratoria ni otras complicaciones. El paciente se mantuvo colaborador, respondió preguntas y movilizó sus extremidades. No presentó complicaciones posoperatorias. Discusión: Dentro de las técnicas anestésicas utilizadas en el mundo la dormido- despierto-dormido es la más popular; sin embargo, constituye una alternativa no dormir nuevamente al paciente ni reinstrumentar la vía respiratoria. Los medicamentos más empleados son el propofol/remifentanilo, aunque la comparación con otros opioides no arrojan diferencias significativas; aunque sí supone un beneficio adicional la dexmedetomidina. Conclusiones: La craneotomía con el paciente despierto es posible de realizar en el entorno hospitalario siempre que exista un equipo multidisciplinario que consensue las mejores acciones médicas para el paciente(AU)


Introduction: Awake craniotomy is useful to achieve wide brain resections of lesions in eloquent areas. Objective: To present the case of a patient who was operated on with the asleep-awake-asleep technique. Method: Anesthesia was induced with propofol-fentanyl-rocuronium and a laryngeal mask was placed. After scalp block, the propofol-fentanyl and lidocaine infusion was maintained until craniotomy was performed. The infusion rate was decreased and remained this way until the end of the intervention. Results: The patient was awakened thirteen minutes after the infusion was reduced. Good hemodynamic stability was maintained, without respiratory depression or other complications. The patient remained collaborative, answered questions, and mobilized his limbs. He had no postoperative complications. Discussion: Among the anesthetic techniques used in the world, asleep-awake-asleep is the most popular. However, it is an alternative not to put the patient back to sleep or re-instrument the airway. The most commonly used drugs are propofol-remifentanil, although the comparison with other opioids does not show significant differences, except for dexmedetomidine, which does represent an additional benefit. Conclusions: Awake craniotomy is possible to be performed in the hospital setting as long as there is a multidisciplinary team that agrees on the best medical actions for the patient(AU)


Subject(s)
Humans , Male , Craniotomy/methods , Intraoperative Awareness/prevention & control , Hemodynamic Monitoring/methods , Laryngeal Masks/standards
4.
Rev. Col. Bras. Cir ; 48: e20202722, 2021. graf
Article in English | LILACS | ID: biblio-1250705

ABSTRACT

ABSTRACT The anesthesia for awake craniotomy (AC) is a consecrated anesthetic technique that has been perfected over the years. Initially used to map epileptic foci, it later became the standard technique for the removal of glial neoplasms in eloquent brain areas. We present an AC anesthesia technique consisting of three primordial times, called awake-asleep-awake, and their respective particularities, as well as delve into the anesthetic medications used. Its use in patients with low and high-grade gliomas was favorable for the resection of tumors within the functional boundaries of patients, with shorter hospital stay and lower direct costs. The present study aims to systematize the technique based on the experience of the largest philanthropic hospital in Latin America and discusses the most relevant aspects that have consolidated this technique as the most appropriate in the surgery of gliomas in eloquent areas.


RESUMO A anestesia para craniotomia em paciente acordado (CPA ou awake craniotomy) é técnica anestésica consagrada e aperfeiçoada ao longo dos últimos anos. Utilizada inicialmente para mapeamento de focos epilépticos, consolidou-se posteriormente como técnica padrão para a remoção de neoplasias de origem glial em áreas eloquentes cerebrais. A técnica de anestesia CPA apresentada constitui-se em três tempos primordiais denominados acordado-dormindo-acordado (asleep-awake-asleep) e respectivas particularidades, assim como o manejo quanto às medicações anestésicas utilizadas de forma pormenorizada. A utilização em gliomas de baixo e de alto grau se demonstrou favorável para a ressecção de tumores dentro dos limites funcionais dos pacientes, com menor tempo de internação hospitalar e de custos diretos. O presente estudo visa realizar a sistematização da técnica baseada na experiência do maior Hospital Filantrópico da América Latina e discute os aspectos mais relevantes que consolidaram essa técnica como a mais adequada na cirurgia dos gliomas em áreas eloquentes.


Subject(s)
Humans , Brain Neoplasms/surgery , Glioma/surgery , Anesthesia , Wakefulness , Craniotomy
5.
Article in Chinese | WPRIM | ID: wpr-880460

ABSTRACT

In neurosurgery, skull repair caused by surgical approach is one of the important research contents. In this paper, a rapid reconstruction method of the skull defect with optical navigation system is proposed. This method can automatically reconstruct the structure of skull defect with the intraoperative defect edge points and preoperative medical image data. The head model experiment was used to evaluate the effect of the method, the average error of the reconstruction of the defect in the right orbit was 0.424 mm, while the average error of the reconstruction of the defect in the posterior skull base was 0.377 mm. The experimental results show that the structure of the defect is consistent with the actual defect, and the reconstruction accuracy satisfies the clinical requirements in neurosurgery.


Subject(s)
Craniotomy , Surgery, Computer-Assisted
6.
Rev. bras. neurol ; 56(3): 29-30, jul.-set. 2020. ilus
Article in English | LILACS | ID: biblio-1120516

ABSTRACT

Zeus is known as the king of the gods and god of the sky. His attributes are lightning and thunder and he is often depicted about to hurl them. According to Greek mythology, Zeus molested the titan Metis and decided to swallow her when she was pregnant, which resulted in an excruciating headache, only relieved after a craniotomy performed using Hephaestus' axe. The result of this procedure was the birth of Athena, Zeus' daughter. We conducted a combined analysis of some writings such as the classical mythological poem Theogony by Hesiod, and some other books that examine and retell myths and legends of ancient Greece, with medical papers on this topic, trying to characterize Zeus' headache. Would it be possible to fit Zeus' headache into the group of thunderclap headaches?


Zeus é conhecido como rei dos deuses e deus dos céus. Tem como atributos os raios e os trovões e é frequentemente representado prestes a lançá-los. De acordo com a mitologia grega, Zeus molestou a titã Métis e resolveu engoli-la grávida, o que resultou em uma cefaleia excruciante, apenas aliviada após uma craniotomia realizada por meio do machado de Hefesto. O fruto deste procedimento foi Atena, filha de Zeus. Realizamos uma análise combinada utilizando escritos mitológicos clássicos como o poema Teogonia de Hesíodo, além de outros livros sobre mitologia e artigos médicos que tratam deste tema, para tentar caracterizar a cefaleia de Zeus. Seria possível enquadrar a cefaleia de Zeus no grupo das cefaleias em trovoada?


Subject(s)
Humans , Craniotomy/history , Headache , Mythology , Headache Disorders , Greece, Ancient
7.
Rev. colomb. psiquiatr ; 49(2): 116-120, abr.-jun. 2020. graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1115652

ABSTRACT

RESUMEN Introducción: El síndrome de Otelo, epónimo del personaje de Shakespeare, es un término diagnóstico transnosológico que designa un cuadro caracterizado por delirios de infidelidad respecto a la pareja que, por consiguiente, puede acarrear actitudes celotípicas y conductas violentas hacia ella. En su forma pura, corresponde al trastorno delirante de infidelidad, pero también puede ser secundario a organicidad cerebral y a consumo de drogas. Métodos: Reporte de caso y revisión no sistemática de la literatura relevante. Presentación del caso: Varón de 26 arios con antecedente de consumo de drogas y víctima de maltrato infantil, 3 años antes había sufrido crisis convulsivas tónico-clónicas e hipertensión intracraneal, por lo que se sometió a una craneotomía, en la que se halló un tuberculoma cerebral frontal derecho. Tras un lapso, comenzó con delirios de infidelidad y conductas violentas hacia su pareja. Revisión de la literatura: Los celos delirantes se asocian, como otros delirios, a lesiones del lóbulo frontal derecho. Pese a la elevada y creciente prevalencia mundial de tuberculosis, no se han publicado casos de síndrome de Otelo secundario a tuberculoma cerebral. Conclusiones: El síndrome de Otelo, aunque no es la principal causa de violencia doméstica, puede asociarse con manifestaciones particularmente violentas y ser secundario a tuberculoma cerebral. Este es el primer caso de tal índole que se publica.


ABSTRACT Introduction: Othello syndrome, an eponym of Shakespeare's character, is a transnosological diagnostic term that designates a clinical picture characterised by the presence of delusions of infidelity with respect to a partner and that, consequently, can lead to typical jealousy attitudes and violent behaviour towards the partner. In its pure form, it corresponds to delusional disorder of infidelity, but it may also be secondary to brain organicity and drug use. Methods: Case report and non-systematic review of the relevant literature. Case presentation: A 26-year-old man, with a history of drug abuse and a victim of domestic violence as a child, presented with tonic-clonic seizures and intracranial hypertension three years ago, for which he underwent a craniotomy with the finding of a right frontal cerebral tuberculoma. After a lapse, he developed a clinical picture of delusions of infidelity regarding his partner and violent behaviour towards her. Literature review: Delusional jealousy is associated, like other delusions, with lesions of the right frontal lobe. Despite the high and growing prevalence of tuberculosis worldwide, there are no reported cases of Othello syndrome secondary to cerebral tuberculoma in the literature. Conclusion: Othello syndrome, although not the main cause of domestic violence, can be associated with particularly violent manifestations and be secondary to cerebral tuberculoma. This is the first published case of its kind.


Subject(s)
Humans , Male , Adult , Syndrome , Substance-Related Disorders , Jealousy , Schizophrenia, Paranoid , Seizures , Attitude , Prevalence , Domestic Violence , Intracranial Hypertension , Craniotomy , Diagnosis , Eponyms , Frontal Lobe
8.
Rev. argent. neurocir ; 34(2): 85-91, jun. 2020. ilus, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1123323

ABSTRACT

Introducción: Diversos estudios demuestran que la tasa de complicaciones asociadas a craneoplastías ha sido subestimada. A mediados de 2016 advertimos una serie de complicaciones asociadas a este procedimiento en nuestro Hospital. Por esto, se decidió cambiar el material que se utilizaba hasta entonces (i.e. polimetilmetracrilato de metilo, PMMAM) por otro distinto (i.e. Titanio). El objetivo del presente trabajo es analizar los resultados post-operatorios obtenidos con PMMAM versus Titanio. Materiales y Métodos: Estudio retrospectivo que incluye a 99 pacientes a los que se les realizó una craneoplastia en nuestro Hospital desde octubre de 2015 a octubre de 2018. Criterios de inclusión: defecto óseo causado tras una craniectomía post-TEC cerrado, sin signos infecciosos, operados en la misma sala operatoria, por el mismo quirúrgico y utilizando la misma técnica para cada material. Para el análisis estadístico se dividió a la muestra en 2 grupos: PMMAM (n= 44) versus Titanio (n=55). Resultados: El 85% (n=86) eran de sexo masculino y la edad promedio fue 29 años (rango: 17-63 años). Se observó una diferencia estadísticamente significativa respecto a los pacientes que desarrollaron determinadas complicaciones entre el grupo PMMAM y el grupo Titanio: colección líquida inflamatoria epidural (14% vs 0%; p=0,006); infección del sitio quirurgico (9% vs 0%; p=0,036) y remoción quirúrgica de la plaqueta (16% vs 0%; p=0,003). Conclusión: Con el uso de malla de titanio se disminuyeron significativamente las complicaciones post-operatorias, respecto al uso de PMMAM


Introduction: Various studies show that the rate of complications associated with cranioplasties has been underestimated. In mid 2016 we noticed a series of complications associated with this procedure in our Hospital. For this reason, it was decided to change the material used until then (i.e. methyl polymethylmethacrylate, PMMAM) for a different one (i.e. Titanium). The objective of this work is to analyze the post-operative results obtained with PMMAM versus Titanium. Materials and Methods: Retrospective study including 99 patients undergoing cranioplasty in our Hospital from October 2015 to October 2018. Inclusion criteria: bone defect was caused after a closed post-TEC craniectomy, without infectious signs, operated in the same operating room, by the same surgeon and using the same technique for each material. For statistical analysis, the sample was divided into two groups: PMMAM (n= 44) versus Titanium (n=55). Results: 85% (n=86) were male and the average age was 29 years (range: 17-63 years). A statistically significant difference was observed with respect to patients who developed certain complications between the PMMAM group and the Titanium group: epidural inflammatory liquid collection (14% vs 0%; p=0.006); surgical site infection (9% vs 0%; p=0.036) and surgical removal of the platelet (16% vs 0%; p=0.003). Conclusion: The use of titanium mesh significantly reduced post-operative complications with respect to the use of PMMAM


Subject(s)
Humans , Craniotomy , Titanium , Reconstructive Surgical Procedures , Brain Injuries, Traumatic
9.
Article in English | WPRIM | ID: wpr-827429

ABSTRACT

OBJECTIVES@#To analyze the risk factors for postoperative deep vein thrombosis (DVT) in neurosurgical patients to provide the basis for the prevention of postoperative DVT.@*METHODS@#A total of 141 patients underwent neurosurgery were enrolled. Thrombelastography (TEG) test was performed before and at the end of surgery. According to whether there was DVT formation after operation, the patients were divided into a thrombosis group and a non-thrombosis group. -test and rank sum test were used to compare the general clinical characteristics of the 2 groups, such as age, gender, intraoperative blood loss, -dimer, intraoperative crystal input, colloid input, blood product transfusion, operation duration, length of postoperative hospitalization. The application of chi-square test and rank-sum test were used to compared TEG main test indicators such as R and K values between the 2 groups. Logistic regression was used to analyze the possible risk factors for postoperative DVT in neurosurgical patients.@*RESULTS@#There were significant differences in postoperative TEG index R, clotting factor function, intraoperative blood loss, hypertension or not, length of postoperative hospital stay, and postoperative absolute bed time (all <0.05). Logistic regression analysis showed hypercoagulability, more intraoperative blood loss and longer postoperative absolute bed time were risk factors for DVT formation after craniotomy.@*CONCLUSIONS@#Hypercoagulability in postoperative TEG test of patients is an important risk factor for the formation of postoperative DVT after neurosurgery, which can predict the occurrence of postoperative DVT to some extent.


Subject(s)
Craniotomy , Humans , Postoperative Complications , Epidemiology , Postoperative Period , Risk Factors , Thrombophilia , Venous Thrombosis , Epidemiology
10.
Rev. cient. Esc. Univ. Cienc. Salud ; 6(2): 27-39, jun.-dic. 2019. tab
Article in Spanish | LILACS | ID: biblio-1117909

ABSTRACT

Introducción: A pesar de los avances científicos, la infección post cirugía sigue siendo importante causa de morbilidad y mortalidad. Objetivos: Determinar tasa de incidencia, analizar factores de riesgo y caracterizar las infecciones del sitio quirúrgico (ISQ). Pacientes y métodos: Estudio cuantitativo, descriptivo, correlacional, retrospectivo de corte transversal, de 117 expedientes de pacientes con craneotomías limpias, que reunieron los criterios de inclusión del servicio de neurocirugía de adulto del Hospital Mario Catarino Rivas de junio del 2016 a mayo del 2017. Resultados: La tasa de incidencia de ISQ fue del 11,97%, que ocupó el primer lugar en incidencia junto con las infecciones de origen pulmonar. Las ISQ en heridas limpias fueron 10% y 30% en heridas con cuerpo extraño. Los agentes etiológicos más frecuentes fueron los bacilos gramnegativos. Los principales factores de riesgo intrínsecos fueron el sexo femenino ([OR] Odds Ratio=3), clasificación ASA I (OR=4.4) y la patología tumoral (OR=3.3); los extrínsecos fueron, hospitalización de más de 30 días (OR=5.4), re-intervenciones (OR=3.8), fuga de Liquido Cefalorraquideo (LCR) (OR=136), transfusión sanguínea (OR=12.6), catéter venoso central (OR=5.3), catéter vesical más de 72 horas (OR=6.7), traqueotomía (OR=4.2), injerto dural (OR=6.5) y sin drenaje postquirúrgico (OR=4.6). Conclusión: La incidencia de ISQ fue alta, con mayor proporción en mujeres y en edad de 31 a 40 años. Tres factores de riesgo intrínsecos y nueve extrínsecos se relacionaron significativamente con ISQ, revelando mayor número de factores modificables.


Subject(s)
Humans , Male , Female , Adult , Operating Rooms/methods , Cross Infection/complications , Risk Factors , Craniotomy
11.
Rev. colomb. anestesiol ; 47(3): 194-197, July-Sept. 2019. graf
Article in English | LILACS, COLNAL | ID: biblio-1013889

ABSTRACT

Abstract We present the case of an adult with an extensive left frontal meningioma. He was scheduled for resection by craniotomy. During the surgery we used the density spectral array (DSA) and asymmetry obtained from Bispectral Index VISTA Monitoring System Bilateral. We observed a power increase in low frequency (0.1-1 Hz) and alpha bands (8-12 Hz) in the left hemisphere, where the meningioma was located. In this case, DSA was useful during and after the surgery because it provided information about the hemisphere with maximum brain activity and its subsequent normalization, which may reflect the effectiveness of the surgery.


Resumen Presentamos el caso de un paciente adulto con diagnóstico de un meningioma extenso a nivel frontal izquierdo, que fue programado para exéresis mediante craneotomía. Durante la cirugía se utilizó la Matriz de Densidad Espectral (MDE) y la asimetría obtenida del Sistema de Monitorización VISTATM del Índice Biespectral Bilateral (BVMS). Se observó un aumento de potencia en las bandas de baja frecuencia (0.1-1Hz) y en las bandas alfa (812 Hz) del hemisferio cerebral izquierdo, donde se encontraba el meningioma. En este caso la MDE demostró su utilidad durante y después de la cirugía, al proporcionar información sobre el hemisferio con registro de máxima actividad cerebral y su posterior normalización, reflejando así la efectividad de la cirugía.


Subject(s)
Humans , Male , Aged, 80 and over , Postoperative Care , Craniotomy , Meningioma , Neurosurgical Procedures , Electroencephalography , Consciousness Monitors
12.
Rev. Assoc. Med. Bras. (1992) ; 65(6): 834-838, June 2019. graf
Article in English | LILACS | ID: biblio-1012976

ABSTRACT

SUMMARY OBJECTIVES: To identify recurrence and its potential predisposing factors in a series of 595 patients with an initial diagnosis of Chronic Subdural Hematoma (CSDH) who underwent surgical treatment at a Reference Hospital of São Paulo. METHODS: A retrospective descriptive study, in which the medical records of all patients with a CSDH diagnosis submitted to surgical treatment from 2000 to 2014 were analyzed. RESULTS: The final study population consisted of 500 patients with a diagnosis of CSDH (95 patients with a diagnosis of Cystic Hygroma were excluded), of which 27 patients presented recurrence of the disease (5.4%). There were no statistically significant differences in relapses when cases were stratified by gender, laterality of the first episode or surgical procedure performed in the first episode (trepanning vs. craniotomy). It was possible to demonstrate an age-related protective factor, analyzed as a continuous variable, regarding the recurrence of the CSDH, with a lower rate of recurrence the higher the age. CONCLUSIONS: The results indicate that, among possible factors associated with recurrence, only age presented a protective factor with statistical significance. The fact that no significant difference between the patients submitted to trepanning or craniotomy was found favors the preferential use of burr-hole surgery as a procedure of choice due to its fast and less complex execution.


RESUMO OBJETIVOS: Identificar a taxa de recidiva e seus potenciais fatores predisponentes em série de 595 pacientes consecutivos com diagnóstico inicial de hematoma subdural crônico (HSDCr) submetidos a tratamento cirúrgico em hospital terciário de São Paulo nos últimos 14 anos. MÉTODOS: Estudo retrospectivo descritivo, no qual foram analisados os prontuários de todos os pacientes com diagnóstico de HSDCr submetidos a tratamento cirúrgico, no período de 2000 a 2014. RESULTADOS: A amostra final consistiu em 500 pacientes com diagnóstico de HSDCr — foram excluídos 95 pacientes com diagnóstico de higroma cístico —, dos quais 27 sujeitos apresentaram recidiva do quadro (5,4%). Não foram observadas diferenças estatisticamente significativas nas recidivas quando os casos foram estratificados por gênero, lateralidade do primeiro episódio ou procedimento cirúrgico executado no primeiro episódio (trepanação vs. craniotomia). Foi possível demonstrar um fator protetor relacionado à idade, analisado como variável contínua, no que diz respeito à recidiva do HSDCr, com menor taxa de recidiva com o avançar desta CONCLUSÕES: Os resultados indicam que, dentre os fatores possivelmente associados à recidiva, apenas a idade se apresentou como fator protetor com significância estatística. O fato de não ser demonstrada diferença significativa entre os pacientes submetidos a tratamentos cirúrgicos por trepanação ou por craniotomia favorece o uso preferencial da trepanação como procedimento de escolha, em virtude de apresentar execução rápida e menos complexa.


Subject(s)
Humans , Male , Female , Aged , Hematoma, Subdural, Chronic/etiology , Recurrence , Logistic Models , Sex Factors , Retrospective Studies , Risk Factors , Age Factors , Treatment Outcome , Craniotomy , Hematoma, Subdural, Chronic/surgery , Middle Aged
13.
Rev. argent. neurocir ; 33(2): 116-118, jun. 2019.
Article in Spanish | LILACS, BINACIS | ID: biblio-1177750

ABSTRACT

Introducción: Los aneurismas carótido-oftálmicos generalmente causan problemas visuales, y su tratamiento quirúrgico sigue siendo un reto debido al objetivo de preservar y/o mejorar la función visual. Descripción del caso: Presentamos caso de intervención quirúrgica de aneurisma carotídeo-oftálmico superior. Masculino de 64 años de edad con déficit de campo visual inferior izquierdo y cefalea. La reconstrucción angio-TC mostró un aneurisma carotídeo-oftálmico superior izquierdo no roto (4x5 mm). Paciente colocado en posición supina, con la cabeza fija en cabezal Sugita de 4 puntos, con una rotación de 15° hacia el lado contralateral. Una craneotomía pterional clásica con fresado del ala esfenoidal, con apertura de la fisura silviana y carotidea se realizaron bajo el microscopio. Se realiza una incisión dural circunferencial sobre el canal óptico. El techo óseo del canal óptico, así como sus paredes medial y lateral, se eliminan cuidadosamente con una fresa diamantada de 3mm con drill de alta velocidad con irrigación constante para evitar daños térmicos sobre el nervio óptico. El nervio óptico con un disector de Penfield N° 7 se eleva suavemente, lejos de la arteria carótida, para facilitar la exposición del cuello aneurismático para el clipado. Resultados: La apertura extensa del canal óptico y la vaina del nervio óptico se logró con éxito en el paciente, lo que permitió un ángulo de trabajo con la arteria carótida para la correcta visualización del aneurisma. Se logró el correcto clipado en el control de AngioCT postoperatoria. Conclusión: La foraminotomía óptica es una técnica fácil y recomendada para exponer y tratar aneurismas carotídeos-oftálmicos superiores y, además, permitir la descompresión del nervio óptico.


Introduction: Carotid-ophthalmic aneurysms usually cause visual problems, and its surgical treatment remains challenging due to the goal of preserving and/or improving the visual outcome. Case description: We present a surgical intervention of superior carotid-ophtalmic aneurysm. A 64-year-old man with a left inferior visual field deficit and headache. The angio CT reconstruction showed a left incidental superior carotid-ophthalmic aneurysm (4x5mm). Patient positioned in supine, with the head fixed in a 4 pin Sugita headholder with a 15° rotation to the contralateral side. A pterional craniotomy and flattening of sphenoid ridge with the usual drilling procedure with the opening of the Sylvian fissure to the carotid cistern were done under the microscope. A circumferential dural incision is made above the optic canal. The bony roof of the optic canal as well as its medial and lateral walls are carefully removed with a 3mm diamond high speed drill under constant irrigation to avoid thermal damage to the optic nerve. The optic nerve becomes gently retractable with a N° 7 Penfield dissector to some extent away from the carotid artery, to facilitate the aneurysmal neck exposure for clipping. Results: Extensive opening of the optic canal and optic nerve sheath was successfully achieved in the patient allowing a working angle with the carotid artery for correct visualization of the aneurysm. The correct clipping was observed in the postoperative AngioCT control. Conclusion: Optic foraminotomy is an easy and recommended technique for exposing and treating superior carotid-ophthalmic aneurysms and moreover allowing optic nerve decompression.


Subject(s)
Humans , Male , Foraminotomy , Optic Nerve , Craniotomy , Aneurysm
14.
Rev. medica electron ; 41(2): 555-563, mar.-abr. 2019. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1004288

ABSTRACT

RESUMEN Los quistes epidermoides constituyen el 1 % de los tumores intracraneales y el 7 % de los del ángulo pontocerebeloso. Los colesteatomas son lesiones benignas que se originan de restos de tejidos epitelial ectodérmicos que quedan en el sistema nervioso central, al cerrarse el tubo neural entre la tercera y quinta semana de gestación. Se trata de un paciente remitido de la Consulta de Neurooftalmología con crisis de cefalea y toma de los pares craneales III, IV, V, rama oftálmica desde hace 2 semanas. Se le realizaron estudios imagenológicos donde se constató un tumor hipodenso en región silviana frontotemporal izquierdo. Se interpretó como un quiste arcnoideo. Se le aplicó un bordaje pterional transilviano con apoyo neuroendoscópico y para sorpresa del equipo quirúrgico se abordó un tumor perlado solido identificado macroscópicamente como un colesteatoma silviano. Se resecó la totalidad del tumor cerebral.


ABSTRACT Epidermal inclusion cysts constitute 1% of the intracranial tumors and 7% of the cerebellopontine angle ones.Cholesteatoma are benign lesions originated from the remains of ectodermic epithelial tissues remaining in the central nervous system when the neural tube closes between the third and fifth week of pregnancy. The case deals with a patient remitted from the Neurophthalmologic Consultation with migraine crisis and lesion on the III, IV, V cranial nerves, ophthalmologic branch, for two weeks. Image studies were carried out, showing a hypo dense tumor in the left silvian frontotemporal region. It was taken as an arachnoid cyst. A pterional trans-silvian approach with neuroendoscopic support was applied, and the surgical team was surprised when they found a solid pearly tumor that was macroscopically identified as a silvian cholesteatoma. The cerebral tumor was totally resected.


Subject(s)
Humans , Male , Aged , Cholesteatoma/surgery , Cholesteatoma/diagnosis , Neurosurgical Procedures , Craniotomy/methods , Neuroendoscopy , Epidermal Cyst/surgery , Epidermal Cyst/diagnosis , Blepharoptosis/diagnosis , Magnetic Resonance Imaging , Exotropia/diagnosis , Tomography, Spiral Computed
15.
Prensa méd. argent ; 105(1): 24-33, mar 2019. fig
Article in Spanish | LILACS, BINACIS | ID: biblio-1026329

ABSTRACT

La presión intracraneal elevada es una complicación devastadora de la lesión neurológica, que puede complicar el trauma, los tumores del sistema nervioso central, la hidrocefalia, la encefalopatía hepática y el flujo venoso del SNC alterado. El adecuado tratamiento consta de un rápido reconocimiento, utilizar material de monitoreo neurológico invasivo y su manejo para reducir la hipertensión intracraneal y sus múltiples causas subyacente. A continuación presentamos una revisión de sus principales características y principios de abordaje diagnóstico-terapéutico


Intracranial pressure is a devastating complication of neurological damage, which can complicate trauma, central nervous system disorders, hydrocephalus, hepatic encephalopathy, and altered CNS venous flow. The appropriate treatment consists of a rapid recognition, the use of an invasive neurological system and its management to reduce intracranial hypertension and its multiple underlying causes. Below we present a review of its main characteristics and principles of diagnostic-therapeutic approach.


Subject(s)
Humans , Perfusion , Intracranial Pressure , Cerebrovascular Circulation , Ultrasonography, Doppler/methods , Intracranial Hypertension/diagnosis , Intracranial Hypertension/prevention & control , Intracranial Hypertension/therapy , Craniotomy , Conservative Treatment
16.
Univ. med ; 60(1)2019. ilus, tab
Article in Spanish | LILACS, COLNAL | ID: biblio-995101

ABSTRACT

El empiema subdural es una patología rara que ocurre secundaria a otra infección en el complejo craneofacial; puede ser por una otitis media o por sinusitis en la mayoría de los casos. Por esto, normalmente, los gérmenes asociados con esta patología son los mismos encontrados en el oído medio y en los senos paranasales. A veces, un microrganismo raro causa el absceso, caso de este paciente, quien ingresó al hospital con dolor ocular y rápidamente progresó a un déficit neurológico causado por la bacteria Aggregatibacter aphrophilus. El caso tuvo una rápida intervención de todos los servicios involucrados. Neurocirugía drenó el empiema mediante trepano; posteriormente, el paciente requirió ventriculostomía y craniectomía descompresiva. El objetivo de esta revisión de la literatura es determinar qué dice la evidencia acerca del drenaje de empiemas mediante trepano o el uso temprano de craniectomía en este tipo de pacientes.


The subdural empyema is a rare pathology that normally occurs secondary' to another infection in the skull-facial complex, could be medial otitis or sinusitis in most of the cases, that's why the germs associated with this pathology' are normally the same found in the middle ear and paranasal sinuses. Eventually a rare microorganism causes an abscess, this is the case of this patient, who arrived to the hospital with ocular pain and rapidly progress with neurological déficit cause by' a bacteria called Aggregatibacter aphrophilus. The case had a fast intervention of all the Services involved, neurosurgery made an empyema drainage by burr hole, after that the patient required ventriculostomy and finally decompressive craniectomy. The objective of this review of the literature is to determine what does the evidence say about the empyema drainage by' burr hole or the early use of craniectomy in this kind of patients.


Subject(s)
Empyema, Subdural/diagnosis , Craniotomy
17.
Article in English | WPRIM | ID: wpr-760002

ABSTRACT

OBJECTIVE: The principle operation of acute subdural hematoma (ASDH) is a craniotomy with hematoma removal, but a trephination with hematoma evacuation may be another method in selected cases. Trephine drainage was performed for ASDH patients in subacute stage using urokinase (UK) instillation, and its results were evaluated. METHODS: Between January 2016 and December 2018, the trephine evacuation using UK was performed in 9 patients. The interval between injury and operation was from 1 to 2 weeks. We underwent a burr hole trephination with drainage initially, and waited until the flow of liquefied hematoma stopped, then instilled UK for the purpose of clot liquefaction. RESULTS: The mean age of patients was 71.6 years (range, 38–90 years). The cause of ASDH was trauma in 8 cases, and supposed a complication of anticoagulant medication in 1 case. Four out of 8 patients took antiplatelet medications and one of them was a chronic alcoholism. The range of the Glasgow Coma Scale score before surgery was from 13 to 15. Most of patients, main symptom was headache at admission. The Glasgow Outcome Scale score was 5 in 8 cases and 3 in 1 case. CONCLUSION: It is thought to be a useful operation method in selected patients with ASDH that the subdural drainage in subacute stage with UK instillation. This method might be another useful option for the patients with good mental state regardless of age and the patients with a risk of bleeding due to antithrombotic medications.


Subject(s)
Alcoholism , Craniotomy , Drainage , Glasgow Coma Scale , Glasgow Outcome Scale , Headache , Hematoma , Hematoma, Subdural, Acute , Hematoma, Subdural, Chronic , Hemorrhage , Humans , Methods , Trephining , Urokinase-Type Plasminogen Activator
18.
Article in English | WPRIM | ID: wpr-760001

ABSTRACT

OBJECTIVE: Chronic subdural hematoma drainage is one of the most common procedures performed in neurosurgical practice. Not only burr hole drainage but also small craniotomy (diameter 3–5 cm) is frequently used neurosurgical treatment of chronic subdural hematomas. We assessed to compare the postoperative recurrence rates between burr hole drainage versus small craniotomy with closed-system drainage for chronic subdural hematomas. METHODS: From January 2016 to December 2018, 75 patients who were treated with burr hole drainage and small craniotomy with closed system drainage for the symptomatic chronic subdural hematoma were enrolled. Pre and postoperative computed tomography (CT) were used for radiologic evaluation. The choice of procedure was decided by preoperative CT images. RESULTS: 60 patients out of 75 patients underwent burr hole drainage, whereas 15 patients underwent small craniotomy. The overall postoperative recurrence rate was 16%. The recurrence occurred in 8 patients out of 60 patients in burr hole drainage group (13.3%) and 7 patients out of 15 patients in small craniotomy group (46.7%). The number of days of hospitalization was 10.3 days in burr hole drainage group and 15.7 days in small craniotomy group. CONCLUSION: Burr hole drainage would be sufficient to evacuate chronic subdural hematoma with lower recurrence rate, but small craniotomy was also needed in some cases such as hematoma has solid portion or multiple septum.


Subject(s)
Craniotomy , Drainage , Hematoma , Hematoma, Subdural, Chronic , Hospitalization , Humans , Recurrence , Trephining
20.
Article in English | WPRIM | ID: wpr-763105

ABSTRACT

BACKGROUND: Racial differences in American patients undergoing brain tumour surgery remain poorly characterized within urban medical centres. Our objective was to assess racial differences in operative brain tumour patients at a single academic hospital in Los Angeles, California. METHODS: We reviewed medical records of adult patients undergoing craniotomy for tumour resection from March 2013 to January 2017 at UCLA Medical Centre. Patients were categorized as Asian, Hispanic, Black, or White. Racial cohorts were matched on demographic variables for comparisons. Our primary outcome was post-operative length of stay (LOS). Secondary outcomes included hospital mortality and discharge disposition. RESULTS: In this study, 462 patients identified as Asian (15.1%), Hispanic (8.7%), Black (3.9%), or White (72.3%). After cohort matching, non-White patients had elevated risk of prolonged LOS [odds ratio (OR)=2.62 (1.44, 4.76)]. No differences were observed in hospital mortality or non-routine discharge. Longer LOS was positively correlated with non-routine discharge [r(pb) (458)=0.41, p<0.001]. Black patients with government insurance had average LOS 2.84 days shorter than Black patients with private insurance (p=0.04). Among Hispanics, government insurance was associated with non-routine discharge [OR=4.93 (1.03, 24.00)]. CONCLUSION: Racial differences manifested as extended LOS for non-White patients, with comparable rates of hospital mortality and non-routine discharge across races. Prolonged LOS loosely reflected complicated clinical course with greater risk of adverse discharge disposition. Private insurance coverage predicted markedly lower risk of non-routine discharge for Hispanic patients, and LOS of three additional days among Black patients. Further research is needed to elucidate the basis of these differences.


Subject(s)
Adult , Asian Continental Ancestry Group , Brain , Brain Neoplasms , California , Cohort Studies , Continental Population Groups , Craniotomy , Hispanic Americans , Hospital Mortality , Humans , Insurance , Insurance Coverage , Length of Stay , Medical Records , Socioeconomic Factors
SELECTION OF CITATIONS
SEARCH DETAIL