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1.
Article in English | WPRIM (Western Pacific) | ID: wprim-782517

ABSTRACT

This study reports the clinical use of two sevoflurane-based anesthetic techniques in dogs undergoing craniectomy. Twenty-one animals undergoing elective rostrotentorial or transfrontal craniectomy for brain tumor excision, anesthetized with sevoflurane, were enrolled in this retrospective, observational study. Anesthetic records were allocated to two groups: Sevo-Op (sevoflurane and short acting opioid infusion): 8 dogs and Sevo-Dex (sevoflurane and dexmedetomidine infusion): 13 dogs. Average mean arterial pressure (MAP), heart rate, end-tidal carbon dioxide, end-tidal sevoflurane and intraoperative infusion rates during surgery were calculated. Presence of intra-operative and post-operative bradycardia, tachycardia, hypotension, hypertension, hypothermia, hyperthermia was recorded. Time to endotracheal extubation, intraoperative occurrence of atrioventricular block, postoperative presence of agitation, seizures, use of labetalol and dexmedetomidine infusion were also recorded. Data from the two groups were compared with Fisher's exact test and unpaired t tests with Welch's correction. Odds ratio (OR) and 95% confidence interval (CI) were calculated for categorical variables. Intra-operatively, MAP was lower in Sevo-Op [85 (± 6.54) vs. 97.69 (± 7.8) mmHg, p = 0.0009]. Time to extubation was longer in Sevo-Dex [37.69 (10–70) vs. 19.63 (10–25), p = 0.0033]. No differences were found for the other intra-operative and post-operative variables investigated. Post-operative hypertension and agitation were the most common complications (11 and 12 out of 21 animals, respectively). These results suggest that the infusion of dexmedetomidine provides similar intra-operative conditions and post-operative course to a short acting opioid infusion during sevoflurane anesthesia in dogs undergoing elective rostrotentorial or transfrontal intracranial surgery.


Subject(s)
Airway Extubation , Anesthesia , Animals , Arterial Pressure , Atrioventricular Block , Bradycardia , Brain Neoplasms , Carbon Dioxide , Dexmedetomidine , Dihydroergotamine , Dogs , Fever , Heart Rate , Hypertension , Hypotension , Hypothermia , Labetalol , Neurosurgery , Observational Study , Odds Ratio , Retrospective Studies , Seizures , Tachycardia
2.
Article in English | WPRIM (Western Pacific) | ID: wprim-811122

ABSTRACT

BACKGROUND: Previous studies have reported what patients value while choosing their surgeon, but there are no studies exploring the patterns of referral to spine surgeons among primary care physicians (PCPs). This study aims to identify any trends in PCPs' referral to orthopedic surgery versus neurosurgery for spinal pathology.METHODS: In total, 450 internal medicine, family medicine, emergency medicine, neurology, and pain management physicians who practice at one of three locations (suburban community hospital, urban academic university hospital, and urban private practice) were asked to participate in the study. Consenting physicians completed our 24-question survey addressing their beliefs according to pathologies, locations of pathologies, and surgical interventions.RESULTS: Overall, 108 physicians (24%) completed our survey. Fifty-seven physicians (52.8%) felt that neurosurgeons would provide better long-term comprehensive spinal care. Overall, 66.7% of physicians would refer to neurosurgery for cervical spine radiculopathy; 52.8%, to neurosurgery for thoracic spine radiculopathy; and 56.5%, to orthopedics for lumbar spine radiculopathy. Most physicians would refer all spine fractures to orthopedics for treatment except cervical spine fractures (56.5% to neurosurgeons). Most physicians would refer to neurosurgery for extradural tumors (91.7%) and intradural tumors (96.3%). Most would refer to orthopedic surgeons for chronic pain. Finally, physicians would refer to orthopedics for spine fusion (61.1%) and discectomy (58.3%) and to neurosurgery for minimally invasive surgery (59.3%).CONCLUSIONS: Even though both orthopedic surgeons and neurosurgeons are intensively trained to treat a similar breath of spinal pathology, physicians vary in their referring patterns according to spinal pathology, location of pathology, and intended surgery. Education on the role of spine surgeons among PCPs is essential in ensuring unbiased referral patterns.


Subject(s)
Chronic Pain , Diskectomy , Education , Emergency Medicine , Hospitals, Community , Humans , Internal Medicine , Minimally Invasive Surgical Procedures , Neurology , Neurosurgeons , Neurosurgery , Orthopedics , Pain Management , Pathology , Physicians, Primary Care , Radiculopathy , Referral and Consultation , Spine , Surgeons
4.
Horiz. méd. (Impresa) ; 19(3): 58-71, Set. 2019. tab, graf
Article in Spanish | LILACS (Americas), LIPECS | ID: biblio-1022382

ABSTRACT

Objetivo: Determinar el nivel de satisfacción del usuario externo de neurocirugía del Instituto Nacional de Ciencias Neurológicas (INCN), Lima, octubre-noviembre, 2016. Materiales y métodos: Estudio cuantitativo, descriptivo, prospectivo y transversal, en 314 usuarios. Se utilizó la encuesta SERVQUAL y se analizó la puntuación media diferencial, análisis ANCOVA y correlación de Spearman. Resultados: La satisfacción global fue 19,4 % (61) y la insatisfacción global, 80,6 % (253) que incluye al insatisfecho leve y moderado. En el 55,1 % (173) de adultos maduros hubo insatisfacción global. La media de las puntuaciones diferenciales para todas las dimensiones fue 0,77; fiabilidad, 0,91; capacidad de respuesta, 0,85; seguridad, 0,44; empatía, 1,03, y aspectos tangibles 0,52. Respecto a la tangibilidad, el adulto maduro es el que presenta mayor insatisfacción con 36,6 % (115), asimismo, para la fiabilidad, 13,3 % (42); respuesta, 46,8 % (147); seguridad, 14,9 % (47); y empatía, 55,1 % (173). Hubo correlación positiva baja, estadísticamente significativa, entre el nivel de estudio del paciente y la satisfacción con la programación de citas (r=0,185), entre el nivel de estudio del paciente y el respeto a la privacidad (r=0,196); y entre el tipo de usuario y la atención rápida de exámenes radiológicos (r=0,184). Hubo correlación negativa baja estadísticamente significativa entre el nivel de estudio y la satisfacción sobre la comprensión de la explicación del neurocirujano sobre su tratamiento (r = -0,212), y los carteles o letreros son adecuados para orientar (r = -0,233), equipos disponibles y materiales para atención (r = -0175), y limpieza de sala de espera y comodidad (r = -0,175). Conclusiones: Se encontró insatisfacción en 4 de cada 5 atendidos. Hubo correlación directa entre el nivel de estudio y programación de citas, y respeto a la privacidad. La procedencia se asocia a comprensión de la explicación del neurocirujano sobre el tratamiento.


Objective: To determine the satisfaction level of neurosurgery outpatients of the Instituto Nacional de Ciencias Neurológicas (INCN), Lima, from October to November 2016. Materials and methods: A quantitative, descriptive, prospective and cross-sectional study was conducted in 314 patients. The study used the SERVQUAL survey to calculate the mean differential score, as well as the ANCOVA analysis and the Spearman's rank correlation coefficient. Results: Overall satisfaction accounted for 19.4 % (61) and overall dissatisfaction, 80.6 % (253), which included both mild and moderate dissatisfaction. Fifty-five point one percent (55.1 %) (173) of middle-aged adults expressed overall dissatisfaction. The mean differential score for all the dimensions reached 0.77 (reliability 0.91, responsiveness 0.85, safety 0.44, empathy 1.03 and tangible aspects 0.52). Middle-aged adults presented dissatisfaction in all dimensions: tangibility 36.6 % (115), reliability 13.3 % (42), responsiveness 46.8 % (147), safety 14.9 % (47) and empathy 55.1 % (173). A statistically significant low positive correlation was observed between patients' education level and satisfaction with appointment scheduling (r = 0.185), patients' education level and respect for privacy (r = 0.196), and type of patient and fast radiological examination service (r = 0.184). A statistically significant low negative correlation was observed between patients' education level and satisfaction with regard to understanding the neurosurgeon's explanations of the treatment (r = -0.212), adequacy of posters and signs for orientation (r = -0.233), availability of equipment and materials needed for healthcare (r = -0.175), and cleanliness and comfort of the waiting room (r = -0.175). Conclusions: Four (4) out of five (5) patients expressed dissatisfaction. A direct correlation was observed between patients' education level and satisfaction with appointment scheduling and respect for privacy. Patients' origin was associated with understanding the neurosurgeon's explanations of the treatment.


Subject(s)
Humans , Patient Satisfaction , Physicians' Offices , Neurosurgery
5.
Rev. medica electron ; 41(4): 1012-1019, jul.-ago. 2019. graf
Article in Spanish | LILACS (Americas), CUMED | ID: biblio-1094105

ABSTRACT

RESUMEN Las alteraciones degenerativas de la columna se engloban en el término de espondilosis cervical. La mielopatía espondilótica cervical (MEC) es la forma más común de disfunción del cordón espinal en mayores de 55 años. Se considera la intervención quirúrgica en la mayoría de los casos de mielopatía cervical espondilótica evidente desde el punto de vista clínico, dado el riesgo de deterioro neurológico. En la mayoría de los casos de mielopatía cervical, la descompresión de la médula espinal genera estabilización o mejoría de la función de los haces largos medulares. La función es mejor cuando se restablecen bien las dimensiones del conducto vertebral después de la descompresión, cuando la descompresión es más precoz y cuando no hay comorbilidad considerable.


ABSTRACT The degenerative alterations of the column are included in the term of cervical espondilosis. The cervical spondylotic myelopathy it is the form more common of disfuntion of the spinal cord in bigger than 55 years. It is considered the surgical intervention in most of the cases of cervical spondylotic myelopathy evident from the clinical, given point of view the risk of neurological deterioration. In most of the cases of cervical myelopathy, the decompression of the spinal marrow generates stabilization or improvement of the function of the medullary long sheaves. The function is better when they recover well the dimensions of the vertebral conduit after the decompression, when the decompression is more precocious and when there is not considerable comorbility.


Subject(s)
Humans , Male , Aged , Arthrodesis , Spinal Cord Diseases/surgery , Spinal Cord Diseases/complications , Spinal Cord Diseases/diagnosis , Spinal Cord Diseases/etiology , Spinal Cord Diseases/drug therapy , Spinal Cord Diseases/diagnostic imaging , Diskectomy , Spondylosis/diagnosis , Intervertebral Disc Degeneration/diagnosis , Spinal Canal/physiopathology , Magnetic Resonance Spectroscopy , Neurosurgery
6.
Coluna/Columna ; 18(2): 138-143, June 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1011951

ABSTRACT

ABSTRACT Objective: Spondylodiscitis is still a frequent pathology among neurosurgical services, and its correct treatment involves infectious, neurological and orthopedic goals. The authors describe the protocol and report the diagnostic and therapeutic results after its implementation. Methods: A prospective prognostic study (Level I) including patients with primary spondylodiscitis treated in the Neurosurgical Service of Cristo Redentor Hospital from January 2014 to March 2018. Demographic, spine, infectious and treatment-related variables were analyzed. The numerical variables are presented as mean and standard deviation or median and interquartile range (according to their parametricity), and are compared by the student's t-Test or Mann-Whitney U Test, respectively. Results: Thirty seven patients were included. The sexes were evenly distributed, with predominantly Caucasians, and a mean age of 56.89 ±15.33. Hypertension and type 2 diabetes were the most frequent comorbidities. Vertebral lumbar level was the most involved segment. Pathogens were identified in 34 cases (91%), with Staphylococcus aureus being the most prevalent, followed by Koch Bacilli. Inflammatory markers are higher in pyogenic infections at hospital admission, but lower at hospital discharge when compared to tuberculous discitis (p<0.01). Mean hospital stay was higher in the pyogenic group. Conclusion: The protocol described has a high diagnostic level of the pathogen, with cure of infection and satisfactory neurologic outcome in all cases. Level of Evidence I, Diagnostic Studies - Investigating a Diagnostic Test.


RESUMO Objetivo: Espondilodiscite é uma patologia frequente nas enfermarias neurocirúrgicas, cujo tratamento adequado envolve questões infecciosas, neurológicas e ortopédicas. Os autores descrevem um protocolo reportando resultados diagnósticos e terapêuticos após sua implementação. Método: Estudo prognóstico prospectivo (Nível I) incluindo pacientes com espondilodiscite primária tratados de janeiro 2014 a março de 2018. Variáveis relacionadas a dados demográficos, vertebrais, infecciosos e terapêuticos foram analisados. Variáveis numéricas serão apresentadas como média e desvio padrão ou mediana e intervalo interquartil (conforme sua parametricidade) e analisadas com Teste T-Student ou Teste Mann-Whittney, respectivamente. Resultados: 37 pacientes foram incluídos, cuja média de idade foi 56.89 ±15.33. Hipertensão arterial e Diabetes foram as comorbidades mais prevalentes. O segmento lombar foi o mais acometido. Houve identificação do patógeno em 34 casos (91%), sendo o Staphylococcus aureus o mais frequente, seguido pelo Bacilo de Koch. Os marcadores inflamatórios foram maiores no grupo de discite piogênica no momento da admissão hospitalar, mas com valores inferiores aos da discite tuberculosa na alta hospitalar (p<0.01). A média de internação hospitalar foi maior no grupo piogênico. Conclusão: O protocolo descrito tem elevada taxa de identificação do patógeno com critérios de cura infecciosa e desfecho neurológico satisfatório em todos os casos descritos. Nível de Evidência I, Estudos diagnósticos - Investigação de um exame para diagnóstico.


RESUMEN Objetivo: La espondilodiscitis sigue siendo una patología frecuente en los servicios de neurocirugía y su tratamiento correcto incluye objetivos infecciosos, neurológicos y ortopédicos. Los autores describen un protocolo e informan los resultados diagnósticos y terapéuticos después de su implementación. Métodos: Estudio pronóstico prospectivo (Nivel I) que incluyó pacientes con espondilodiscitis primaria tratados en el Servicio de Neurocirugía del Hospital Cristo Redentor desde enero de 2014 hasta marzo de 2018. Se analizaron variables demográficas, vertebrales, infecciosas y relacionadas con el tratamiento. Las variables numéricas se presentan como promedio y la desviación estándar o mediana y rango intercuartil (según su parametricidad) y se comparan mediante la prueba t de Student o la prueba U de Mann-Whitney, respectivamente. Resultados: Se incluyeron 37 pacientes. Los sexos se distribuyeron uniformemente, con predominancia de caucásicos y una edad promedio de 56,89 ± 15,33. La hipertensión y la diabetes tipo 2 fueron las comorbilidades más frecuentes. El nivel lumbar fue el segmento más afectado. Se identificaron patógenos en 34 casos (91%), siendo el Staphylococcus aureus el más frecuente, seguido por el bacilo de Koch. Los marcadores inflamatorios fueron más en las infecciones piógenas en el hospital, pero más bajos en el alta hospitalaria en comparación con la discitis tuberculosa (p < 0,01). La estancia hospitalaria promedio fue mayor en el grupo piógeno. Conclusiones: El protocolo descrito tiene un alto nivel de diagnósticos del patógeno, con curación de la infección y resultados neurológicos satisfactorios en todos los casos. Nivel de Evidencia I, Estudios de diagnósticos - Investigación de un examen para diagnóstico.


Subject(s)
Humans , Spine , Discitis , Infections , Neurosurgery
7.
Article in English | WPRIM (Western Pacific) | ID: wprim-788825

ABSTRACT

The Korean Women Neurosurgical Society (KWNS) was founded in 2008. To commemorate its 10th anniversary, herein we review its history and the status of Korean Neurosurgical Society (KNS)-certified women neurosurgeons. Based on the academic and social activity of the KWNS, we can expect to promote professional work as members of the KNS, facilitate interaction among neurosurgeons, and sustain professional careers.


Subject(s)
Anniversaries and Special Events , Female , Humans , Neurosurgeons , Neurosurgery
8.
Article in English | WPRIM (Western Pacific) | ID: wprim-788812

ABSTRACT

OBJECTIVE: Since less invasive endovascular treatment was introduced to South Korea in 1994, a considerable proportion of endovascular treatments have been performed by neuroradiology doctors, and endovascular treatments by vascular neurosurgeons have recently increased. However, few specific statistics are known regarding how many endovascular treatments are performed by neurosurgeons. Thus, authors compared endovascular treatments collaboratively performed by vascular neurosurgeons with all cases throughout South Korea from 2013 to 2017 to elucidate the role of neurosurgeons in the field of endovascular treatment in South Korea.METHODS: The Society of Korean Endovascular Neurosurgeons (SKEN) has issued annual reports every year since 2014. These reports cover statistics on endovascular treatments collaboratively or individually performed by SKEN members from 2013 to 2017. The data was requested and collected from vascular neurosurgeons in various hospitals. The study involved 77 hospitals in its first year, and 100 in its last. National statistics on endovascular treatment from all over South Korea were obtained from the Healthcare Bigdata Hub website of the Health Insurance Review & Assessment Service based on the Electronic Data Interchange (EDI) codes (in the case of intra-arterial (IA) thrombolysis, however, statistics were based on a combination of the EDI and I63 codes, a cerebral infarction disease code) from 2013 to 2017. These two data sets were directly compared and the ratios were obtained.RESULTS: Regionally, during the entire study period, endovascular treatments by SKEN members were most common in Gyeonggi-do, followed by Seoul and Busan. Among the endovascular treatments, conventional cerebral angiography was the most common, followed by cerebral aneurysmal coiling, endovascular treatments for ischemic stroke, and finally endovascular treatments for vascular malformation and tumor embolization. The number of endovascular treatments performed by SKEN members increased every year.CONCLUSION: The SKEN members have been responsible for the major role of endovascular treatments in South Korea for the recent 5 years. This was achieved through the perseverance of senior members who started out in the midst of hardship, the establishment of standards for the training/certification of endovascular neurosurgery, and the enthusiasm of current SKEN members who followed. To provide better treatment to patients, we will have to make further progress in SKEN.


Subject(s)
Cerebral Angiography , Cerebral Infarction , Data Interpretation, Statistical , Dataset , Delivery of Health Care , Endovascular Procedures , Humans , Insurance, Health , Intracranial Aneurysm , Korea , Neurosurgeons , Neurosurgery , Seoul , Stroke , Vascular Malformations
9.
Article in English | WPRIM (Western Pacific) | ID: wprim-788772

ABSTRACT

Epilepsy surgery that eliminates the epileptogenic focus or disconnects the epileptic network has the potential to significantly improve seizure control in patients with medically intractable epilepsy. Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has been an established option for epilepsy surgery since the US Food and Drug Administration cleared the use of MRgLITT in neurosurgery in 2007. MRgLITT is an ablative stereotactic procedure utilizing heat that is converted from laser energy, and the temperature of the tissue is monitored in real-time by MR thermography. Real-time quantitative thermal monitoring enables titration of laser energy for cellular injury, and it also estimates the extent of tissue damage. MRgLITT is applicable for lesion ablation in cases that the epileptogenic foci are localized and/or deep-seated such as in the mesial temporal lobe epilepsy and hypothalamic hamartoma. Seizure-free outcomes after MRgLITT are comparable to those of open surgery in well-selected patients such as those with mesial temporal sclerosis. Particularly in patients with hypothalamic hamartoma. In addition, MRgLITT can also be applied to ablate multiple discrete lesions of focal cortical dysplasia and tuberous sclerosis complex without the need for multiple craniotomies, as well as disconnection surgery such as corpus callosotomy. Careful planning of the target, the optimal trajectory of the laser probe, and the appropriate parameters for energy delivery are paramount to improve the seizure outcome and to reduce the complication caused by the thermal damage to the surrounding critical structures.


Subject(s)
Anterior Temporal Lobectomy , Craniotomy , Drug Resistant Epilepsy , Epilepsy , Epilepsy, Temporal Lobe , Hamartoma , Hot Temperature , Humans , Laser Therapy , Malformations of Cortical Development , Neurosurgery , Sclerosis , Seizures , Thermography , Tuberous Sclerosis , United States Food and Drug Administration
10.
Article in English | WPRIM (Western Pacific) | ID: wprim-788771

ABSTRACT

Epilepsy has been known to humankind since antiquity. The surgical treatment of epilepsy began in the early days of neurosurgery and has developed greatly. Many surgical procedures have stood the test of time. However, clinicians treating epilepsy patients are now witnessing a huge tide of change. In 2017, the classification system for seizure and epilepsy types was revised nearly 36 years after the previous scheme was released. The actual difference between these systems may not be large, but there have been many conceptual changes, and clinicians must bid farewell to old terminology. Paradigms in drug discovery are changing, and novel antiseizure drugs have been introduced for clinical use. In particular, drugs that target genetic changes harbor greater therapeutic potential than previous screening-based compounds. The concept of focal epilepsy has been challenged, and now epilepsy is regarded as a network disorder. With this novel concept, stereotactic electroencephalography (SEEG) is becoming increasingly popular for the evaluation of dysfunctioning neuronal networks. Minimally invasive ablative therapies using SEEG electrodes and neuromodulatory therapies such as deep brain stimulation and vagus nerve stimulation are widely applied to remedy dysfunctional epilepsy networks. The use of responsive neurostimulation is currently off-label in children with intractable epilepsy.


Subject(s)
Child , Classification , Deep Brain Stimulation , Drug Discovery , Drug Resistant Epilepsy , Electrodes , Electroencephalography , Epilepsies, Partial , Epilepsy , Humans , Neurons , Neurosurgery , Seizures , Vagus Nerve Stimulation
11.
Article in English | WPRIM (Western Pacific) | ID: wprim-719532

ABSTRACT

Fibrous dysplasia (FD) is a non-malignant bone tumor that typically behaves as a slow and indolent growing mass lesion. We report the case of a female patient presenting with headache and facial deformity and later diagnosed with polyostotic fibrous dysplasia (PFD). A 29-year-old woman visited Mealhada Primary Health Care Unit complaining of headache, nasal congestion, and hyposmia for several weeks. She also presented with facial deformity and painful swelling of the upper left orbit. X-ray imaging revealed a suspicious opacity in the left frontal sinus and a right shift of the nasal septum. Computed tomography and bone scintigraphy later confirmed a tumor involving the ethmoid and frontal bone. The patient was referred to the neurosurgery and otorhinolaryngology departments of a central hospital and the suspected diagnosis of PFD was confirmed. A watchful waiting approach with regular imaging screenings was proposed and accepted by the patient, who is now free of symptoms and more acceptant of the benign condition of her tumor. With this case, we aim to make family physicians more aware of this rare but relevant condition that can be difficult to diagnose. FD is a rare but benign tumor that occurs mainly in adolescents and young adults. Symptoms depend on the location and type of the tumor and include facial deformity, vision changes, nasal congestion, and headache. No clear guidelines exist for its treatment, and options include monitoring the progression of the tumor, in addition to medical or surgical approaches.


Subject(s)
Adolescent , Adult , Bone Neoplasms , Congenital Abnormalities , Diagnosis , Estrogens, Conjugated (USP) , Female , Fibrous Dysplasia of Bone , Fibrous Dysplasia, Polyostotic , Frontal Bone , Frontal Sinus , Headache , Humans , Mass Screening , Nasal Septum , Neurosurgery , Orbit , Otolaryngology , Physicians, Family , Primary Health Care , Radionuclide Imaging , Watchful Waiting , Young Adult
12.
Article in English | WPRIM (Western Pacific) | ID: wprim-739671

ABSTRACT

BACKGROUND: One of the most frequent complications after endoscopic endonasal approach (EEA) for resection of pituitary tumors is cerebrospinal fluid (CSF) leaks. With the introduction of the pedicled nasoseptal flap, the reconstruction of the skull base has improved significantly resulting in a decrease in the occurrence of persistent CSF leaks. We present our experience utilizing the pedicled nasoseptal flap technique after EEA for reconstruction of the skull base in cases where CSF leak was detected. METHODS: Data for patients undergoing EEA for pituitary tumors was retrospectively reviewed. These included demographic, clinical, operative, radiographic, and pathological information. Incidence of post-operative complications and CSF leaks were recorded. Descriptive statistical analysis was performed. RESULTS: Between 2008 and 2015, 67 patients and 69 hospital admissions with pituitary tumors underwent a nasoseptal flap to reconstruct a skull base defect at Johns Hopkins Hospital. The mean age at surgery was 54.5±14.2 years. Fifty-two percent of patients were male. Forty-six percent of patients were white, 33% African-American, and 12% belonged to other racial groups. There was an intraoperative CSF leak in 39% of patients. Seventy percent of patients with an intraoperative CSF leak had a nasoseptal flap reconstruction of the skull base. There were zero postoperative CSF leaks. CONCLUSION: With the introduction of the pedicled nasoseptal flap for reconstruction of the skull base after EEA for resection of pituitary adenomas, the incidence of postoperative CSF leaks has decreased significantly. In this retrospective analysis, we demonstrate the effectiveness of the use of nasoseptal flap in repairing CSF leak after EEA.


Subject(s)
Adenoma , Cerebrospinal Fluid Leak , Cerebrospinal Fluid , Humans , Incidence , Male , Neurosurgery , Pituitary Neoplasms , Retrospective Studies , Skull Base
13.
Article in English | WPRIM (Western Pacific) | ID: wprim-741364

ABSTRACT

PURPOSE: To investigate the prevalence of occult spinal dysraphism (OSD) and subsequent neurosurgery in pediatric patients with isolated or combined dorsal midline cutaneous stigmata with or without other congenital malformations. METHODS: We carried out a retrospective review of patients who underwent sonography or magnetic resonance imaging (MRI) for OSD because of suspicion of dorsal midline cutaneous stigmata (presumed to be a marker for OSD) between January 2012 and June 2017. Information about patient characteristics, physical examination findings, spinal ultrasound and MRI results, neurosurgical notes, and accompanying congenital anomalies was collected. RESULTS: Totally 250 patients (249 ultrasound and one MRI screening) were enrolled for analysis. Eleven patients underwent secondary MRI examinations. The prevalence of OSD confirmed by an MRI was 2.4% (6 patients including one MRI screening). Five patients (2%) had tethered cord and underwent prophylactic neurosurgery, 3 of whom had a sacrococcygeal dimple and a fibrofatty mass. Prevalence of tethered cord increased as markers associated with a sacrococcygeal dimple increased (0.5% of the isolated marker group, 8.1% of the 2-marker group, and 50% of the 3-marker group). Incidence of OSD with surgical detethering in 17 other congenital anomaly patients was 11.8%, which was higher than the 1.3% in 233 patients without other congenital anomalies. CONCLUSION: Our results suggest that the presence of dorsal midline cutaneous stigmata, particularly fibrofatty masses, along with a sacrococcygeal dimple is associated with OSD or cord tethering requiring surgery. OSD should be suspected in patients with concurrent occurrence of other congenital anomalies.


Subject(s)
Christianity , Congenital Abnormalities , Humans , Incidence , Magnetic Resonance Imaging , Neural Tube Defects , Neurosurgery , Physical Examination , Prevalence , Retrospective Studies , Ultrasonography
14.
Article in English | WPRIM (Western Pacific) | ID: wprim-764391

ABSTRACT

Mounier-Kuhn syndrome (MKS) is a disease characterized by dilation of the trachea and mainstem bronchi. Due to the risk of airway leakage, pulmonary aspiration, and tracheal damage, MKS can be fatal in patients undergoing tracheal intubation. Moreover, MKS may not be diagnosed preoperatively due to its rarity. In this case, a patient undergoing neurosurgery was incidentally diagnosed with MKS during general anesthesia. During anesthesia induction, difficulties in airway management led the anesthesiologist to suspect MKS. Airway leakage was resolved in this case using oropharyngeal gauze packing. Anesthesiologists should be aware of the possibility of MKS and appropriate management of the airways.


Subject(s)
Airway Management , Anesthesia , Anesthesia, General , Bronchi , Humans , Intubation , Intubation, Intratracheal , Neurosurgery , Trachea , Tracheobronchomegaly
15.
Article in English | WPRIM (Western Pacific) | ID: wprim-765399

ABSTRACT

The Korean Women Neurosurgical Society (KWNS) was founded in 2008. To commemorate its 10th anniversary, herein we review its history and the status of Korean Neurosurgical Society (KNS)-certified women neurosurgeons. Based on the academic and social activity of the KWNS, we can expect to promote professional work as members of the KNS, facilitate interaction among neurosurgeons, and sustain professional careers.


Subject(s)
Anniversaries and Special Events , Female , Humans , Neurosurgeons , Neurosurgery
16.
Article in English | WPRIM (Western Pacific) | ID: wprim-765385

ABSTRACT

OBJECTIVE: Since less invasive endovascular treatment was introduced to South Korea in 1994, a considerable proportion of endovascular treatments have been performed by neuroradiology doctors, and endovascular treatments by vascular neurosurgeons have recently increased. However, few specific statistics are known regarding how many endovascular treatments are performed by neurosurgeons. Thus, authors compared endovascular treatments collaboratively performed by vascular neurosurgeons with all cases throughout South Korea from 2013 to 2017 to elucidate the role of neurosurgeons in the field of endovascular treatment in South Korea. METHODS: The Society of Korean Endovascular Neurosurgeons (SKEN) has issued annual reports every year since 2014. These reports cover statistics on endovascular treatments collaboratively or individually performed by SKEN members from 2013 to 2017. The data was requested and collected from vascular neurosurgeons in various hospitals. The study involved 77 hospitals in its first year, and 100 in its last. National statistics on endovascular treatment from all over South Korea were obtained from the Healthcare Bigdata Hub website of the Health Insurance Review & Assessment Service based on the Electronic Data Interchange (EDI) codes (in the case of intra-arterial (IA) thrombolysis, however, statistics were based on a combination of the EDI and I63 codes, a cerebral infarction disease code) from 2013 to 2017. These two data sets were directly compared and the ratios were obtained. RESULTS: Regionally, during the entire study period, endovascular treatments by SKEN members were most common in Gyeonggi-do, followed by Seoul and Busan. Among the endovascular treatments, conventional cerebral angiography was the most common, followed by cerebral aneurysmal coiling, endovascular treatments for ischemic stroke, and finally endovascular treatments for vascular malformation and tumor embolization. The number of endovascular treatments performed by SKEN members increased every year. CONCLUSION: The SKEN members have been responsible for the major role of endovascular treatments in South Korea for the recent 5 years. This was achieved through the perseverance of senior members who started out in the midst of hardship, the establishment of standards for the training/certification of endovascular neurosurgery, and the enthusiasm of current SKEN members who followed. To provide better treatment to patients, we will have to make further progress in SKEN.


Subject(s)
Cerebral Angiography , Cerebral Infarction , Data Interpretation, Statistical , Dataset , Delivery of Health Care , Endovascular Procedures , Humans , Insurance, Health , Intracranial Aneurysm , Korea , Neurosurgeons , Neurosurgery , Seoul , Stroke , Vascular Malformations
17.
Article in English | WPRIM (Western Pacific) | ID: wprim-765344

ABSTRACT

Epilepsy surgery that eliminates the epileptogenic focus or disconnects the epileptic network has the potential to significantly improve seizure control in patients with medically intractable epilepsy. Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has been an established option for epilepsy surgery since the US Food and Drug Administration cleared the use of MRgLITT in neurosurgery in 2007. MRgLITT is an ablative stereotactic procedure utilizing heat that is converted from laser energy, and the temperature of the tissue is monitored in real-time by MR thermography. Real-time quantitative thermal monitoring enables titration of laser energy for cellular injury, and it also estimates the extent of tissue damage. MRgLITT is applicable for lesion ablation in cases that the epileptogenic foci are localized and/or deep-seated such as in the mesial temporal lobe epilepsy and hypothalamic hamartoma. Seizure-free outcomes after MRgLITT are comparable to those of open surgery in well-selected patients such as those with mesial temporal sclerosis. Particularly in patients with hypothalamic hamartoma. In addition, MRgLITT can also be applied to ablate multiple discrete lesions of focal cortical dysplasia and tuberous sclerosis complex without the need for multiple craniotomies, as well as disconnection surgery such as corpus callosotomy. Careful planning of the target, the optimal trajectory of the laser probe, and the appropriate parameters for energy delivery are paramount to improve the seizure outcome and to reduce the complication caused by the thermal damage to the surrounding critical structures.


Subject(s)
Anterior Temporal Lobectomy , Craniotomy , Drug Resistant Epilepsy , Epilepsy , Epilepsy, Temporal Lobe , Hamartoma , Hot Temperature , Humans , Laser Therapy , Malformations of Cortical Development , Neurosurgery , Sclerosis , Seizures , Thermography , Tuberous Sclerosis , United States Food and Drug Administration
18.
Article in English | WPRIM (Western Pacific) | ID: wprim-765343

ABSTRACT

Epilepsy has been known to humankind since antiquity. The surgical treatment of epilepsy began in the early days of neurosurgery and has developed greatly. Many surgical procedures have stood the test of time. However, clinicians treating epilepsy patients are now witnessing a huge tide of change. In 2017, the classification system for seizure and epilepsy types was revised nearly 36 years after the previous scheme was released. The actual difference between these systems may not be large, but there have been many conceptual changes, and clinicians must bid farewell to old terminology. Paradigms in drug discovery are changing, and novel antiseizure drugs have been introduced for clinical use. In particular, drugs that target genetic changes harbor greater therapeutic potential than previous screening-based compounds. The concept of focal epilepsy has been challenged, and now epilepsy is regarded as a network disorder. With this novel concept, stereotactic electroencephalography (SEEG) is becoming increasingly popular for the evaluation of dysfunctioning neuronal networks. Minimally invasive ablative therapies using SEEG electrodes and neuromodulatory therapies such as deep brain stimulation and vagus nerve stimulation are widely applied to remedy dysfunctional epilepsy networks. The use of responsive neurostimulation is currently off-label in children with intractable epilepsy.


Subject(s)
Child , Classification , Deep Brain Stimulation , Drug Discovery , Drug Resistant Epilepsy , Electrodes , Electroencephalography , Epilepsies, Partial , Epilepsy , Humans , Neurons , Neurosurgery , Seizures , Vagus Nerve Stimulation
19.
Article in Chinese | WPRIM (Western Pacific) | ID: wprim-774188

ABSTRACT

Neurosurgery navigation system, which is expensive and complicated to operate, has a low penetration rate, and is only found in some large medical institutions. In order to meet the needs of other small and medium-sized medical institutions for neurosurgical navigation systems, the scalp localization system of neurosurgery based on augmented reality (AR) theory was developed. AR technology is used to fuse virtual world images with real images. The system integrates computed tomography (CT) or magnetic resonance imaging (MRI) with the patient's head in real life to achieve the scalp positioning. This article focuses on the key points of Digital Imaging and Communications in Medicine (DICOM) standard, three-dimensional (3D) reconstruction, and AR image layer fusion in medical image visualization. This research shows that the system is suitable for a variety of mobile phones, can achieve two-dimensional (2D) image display, 3D rendering and clinical scalp positioning application, which has a certain significance for the auxiliary neurosurgical head surface positioning.


Subject(s)
Humans , Imaging, Three-Dimensional , Magnetic Resonance Imaging , Neurosurgery , Methods , Scalp , Tomography, X-Ray Computed
20.
Rev. Hosp. El Cruce ; (23): 15-20, 19/12/2018.
Article in Spanish | LILACS (Americas), BINACIS | ID: biblio-967978

ABSTRACT

Existen casos en cirugía craneal que requieren reconstrucción de defectos óseos por trauma, corrección defectos congénitos, infección de plaqueta ósea, entre otros. El principal objetivo de la reconstrucción de un defecto óseo en la zona craneal es proveer de protección a regiones y órganos vulnerables (cerebro, coberturas meníngeas). Se estudian alternativas con la finalidad de realizar un procedimiento que garantice buenos resultados estéticos y funcionales. Por ello se propuso desarrollar moldes utilizando impresión 3D de bajo costo para confección en quirófano de craneoplastías personalizadas en pacientes craniectomizados.


There are cases in cranial surgery that require reconstruction of bone defects due to trauma, correction of congenital defects, bone platelet infection, among others. The main objective of the reconstruction of a bone defect in the cranial area is to provide protection to vulnerable regions and organs (brain, meningeal coverages). Alternatives are studied in order to perform a procedure that guarantees good aesthetic and functional results. For this reason, it was proposed to develop molds using low cost 3D printing for the manufacture in the operating room of personalized cranioplasty in craniectomized patients.


Subject(s)
Prosthesis Design , Craniotomy , Printing, Three-Dimensional , Neurosurgery
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