ABSTRACT
OBJECTIVE: Frailty has been shown to affect patient outcomes after medical and surgical interventions. The Hospital Frailty Risk Score (HFRS) is a growing metric used to assess patient frailty using International Classification of Diseases, Tenth Revision codes. The goal of this study was to investigate the impact of frailty, assessed by HFRS, on health care resource utilization and outcomes in patients undergoing surgery for spinal meningiomas. METHODS: A retrospective cohort study was performed using the 2016-2019 National Inpatient Sample database. Adult patients with benign or malignant spinal meningiomas, identified using International Classification of Diseases, Tenth Revision, Clinical Modification codes, were stratified by HFRS: low frailty (HFRS <5) and intermediate-high frailty (HFRS ≥5). Patient demographics, hospital characteristics, comorbidities, procedural variables, adverse events, length of stay (LOS), discharge disposition, and cost of admission were assessed. Multivariate regression analysis was used to identify predictors of increased LOS, discharge disposition, and cost. RESULTS: Of the 3345 patients, 530 (15.8%) had intermediate-high frailty. The intermediate-high cohort was significantly older (P < 0.001). More patients in the intermediate-high cohort had ≥3 comorbidities (P < 0.001). In addition, a greater proportion of patients in the intermediate-high cohort experienced ≥1 perioperative adverse events (P < 0.001). Intermediate-high patients experienced greater mean LOS (P < 0.001) and accrued greater costs (P < 0.001). A greater proportion of intermediate-high patients had nonroutine discharges (P < 0.001). On multivariate analysis, increased HFRS (≥5) was independently associated with extended LOS (adjusted odds ratio [aOR], 3.04; P < 0.001), nonroutine discharge (aOR, 1.98; P = 0.006), and increased costs (aOR, 2.39; P = 0.004). CONCLUSIONS: Frailty may be associated with increased health care resource utilization in patients undergoing surgery for spinal meningiomas.
Subject(s)
Frailty , Meningeal Neoplasms , Meningioma , Adult , Humans , Retrospective Studies , Meningioma/epidemiology , Meningioma/surgery , Frailty/epidemiology , Prevalence , Length of Stay , Hospitals , Risk Factors , Postoperative Complications/epidemiologyABSTRACT
MATERIAL AND METHODS: A case of 60-year-old woman with idiopathic syringomyelia and progressive myelopathy by dorsal arachnoid web is discussed. One focal indentation along the dorsal surface of the spinal cord at the T3 vertebral body level revealed the scalpel sign, a radiologic entity diagnostic of a dorsal thoracic arachnoid web. RESULTS: T2-T3 laminectomy for the resection of dorsal arachnoid band was performed. Careful sectioning of the web resulted in visual apparent relief of the compression and good functional recovery. CONCLUSION: In patients with presumed idiopathic syringomyelia, imaging studies should be closely inspected for the presence of transverse arachnoid web. This extramedullary transverse band of arachnoid tissue extends to dorsal surface of the spinal cord, resulting in mass effect and dorsal indentation, known as scalpel sign because of its apparent resemblance to a scalpel on sagittal imaging. Early diagnosis with early intervention may benefit greatly patients. Surgical resection of transverse arachnoid web is a minimally invasive procedure with low morbidity, and can result in resolution of syringomyelia and improvement in neurological function.
ABSTRACT
PURPOSE: This paper proposes a practical model of microneurosurgical training using a nonliving swine head. METHODS: Fresh porcine heads were obtained from butchery and dissected at our Laboratory of Microsurgery. Brain and skull base surgery were trained under microscopic magnification. RESULTS: Several neurosurgical procedures could be simulated in the nonliving pig model, including transcallosal approach to the lateral ventricle, lateral sulcus and middle fossa dissection, and posterior fossa surgery. CONCLUSION: The swine model perfectly simulates standard microneurosurgical procedures, and is a useful tool for developing and refining surgical skills.
Subject(s)
Brain/surgery , Microsurgery/education , Models, Animal , Neurosurgical Procedures/education , Animals , Clinical Competence , Dissection/education , Reproducibility of Results , SwineABSTRACT
PURPOSE: This paper proposes a practical model of microneurosurgical training using a nonliving swine head. METHODS: Fresh porcine heads were obtained from butchery and dissected at our Laboratory of Microsurgery. Brain and skull base surgery were trained under microscopic magnification. RESULTS: Several neurosurgical procedures could be simulated in the nonliving pig model, including transcallosal approach to the lateral ventricle, lateral sulcus and middle fossa dissection, and posterior fossa surgery. CONCLUSION: The swine model perfectly simulates standard microneurosurgical procedures, and is a useful tool for developing and refining surgical skills. .
Subject(s)
Animals , Brain/surgery , Models, Animal , Microsurgery/education , Neurosurgical Procedures/education , Clinical Competence , Dissection/education , Reproducibility of Results , SwineABSTRACT
Objective: Evaluate clinical outcome of dorsal root ganglia (DRG) pulsed radiofrequency (PRF) treatment in neuropathic pain of patients with radiculopathy regarding improvement of pain and degree of patients? satisfaction. Method: Forty-five procedures in cervical and lumbossacral spine. Data collected by phone call interviews (independent researcher). Evaluation done after one month and at minimum three months follow-up. Analyzed data included objective and subjective improvement, and degree of satisfaction. Results: Outcome much better in 31%, 36% better, 24% unchanged, 9% worse. At initial evaluation, relief was rated: 24% excellent, 16% good, 27% moderate, 33% poor. At late evaluation, 27% excellent, 18% good, 7% moderate, 49% poor. Degree of satisfaction was high (82% of patients reported they certainly or probably would repeat the procedure). Conclusion: PRF was effective and safe in selected patients. Most patients were satisfied and would repeat/recommend the procedure...
Objetivo: Avaliar a evolução clínica do tratamento com radiofrequência pulsada (RFP) de gânglio da raiz dorsal (GRD) na dor neuropática em pacientes com radiculopatia, considerando melhora da dor e grau de satisfação dos pacientes. Método: Quarenta e cinco procedimentos na coluna cervical e lombossacra. Os dados foram coletados por meio de entrevistas telefônicas (pesquisador independente). Avaliação inicial feita após um mês e final no mínimo de três meses de acompanhamento. Dados analisados incluíram melhora objetiva, subjetiva e o grau de satisfação. Resultados: Evolução ?muito melhor? em 31%, ?melhor? em 36%, ?inalterado? em 24%, ?pior? em 9%. Na avaliação inicial: 24% ?excelente?, 16% ?bom?, 27% ?moderada?, 33% ?pobre?. Na avaliação final, 27% ?excelente?, 18% ?bom?, 7% ?moderada?, 49% ?pobre?. O grau de satisfação foi elevado (82% dos pacientes relataram que certamente ou provavelmente repetiriam o procedimento). Conclusão: RFP foi eficaz e segura em pacientes selecionados. A maioria dos pacientes ficou satisfeita e repetiu/recomendou o procedimento...
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Pain, Intractable/radiotherapy , Ganglia, Spinal , Radiculopathy/radiotherapy , Electrodes, ImplantedABSTRACT
Os avanços em técnicas de doppler pulsado facilitaram sua utilização na Neurocirurgia, especialmente para o acesso às artérias envolvidas por tumores, através da identificação e localização das mesmas. O objetivo desse estudo é descrever a técnica de doppler microvascular associado à neuronavegação em cirurgia endoscópica transesfenoidal para remoção demacroadenomas pituitários em três pacientes. Material e Métodos: Uma sonda de 16 MHz (2 mm) foi inserida em uma cânula de 17 cm de comprimento e anexada a um indicador de neuronavegação. O planejamento pré-operatório foi realizado com RM e angiotomografia. Resultados: O doppler microvascular intraoperatório identificou fluxo arterial compatível com a localização anatômica da porção cavernosa da artéria carótida interna, conforme demonstrado pelo sistema de neuronavegação,possibilitando a manipulação do tumor sem risco de danos à artéria. Em todos os três casos ocorreu a remoção total de tumor sem o comprometimento da artéria carótida interna. Conclusão: O método com doppler microvascular associado à neuronavegação foi essencial ao diagnóstico vascular intraoperatório, permitindo ressecções tumorais radicais e, ao mesmo tempo, evitando danos arteriais.
Subject(s)
Carotid Artery, Internal , Neuronavigation , Ultrasonography, Doppler, TranscranialABSTRACT
A instabilidade atlantoaxial possui múltiplas causas e muitas vezes requer tratamento cirúrgico. Várias técnicas estão disponíveis para realização da fixação atlantoaxial, todas elas com diferentes vantagens e desvantagens. Em 2004, Wrigth descreveu a técnica de fixação translaminar de C2, que oferece uma fixação rígida, porém sem a dificuldade técnica da colocação de parafusos na pars de C2 e com eliminação do risco de lesão da artéria vertebral. O objetivo deste estudo é revisar a técnica de fixação translaminar de C2, enfatizando detalhes técnicos, risco e benefícios em comparação com as outras técnicas de fixação atlantoaxial.
Subject(s)
Atlanto-Axial Joint , Spinal Fusion , SpineABSTRACT
Objetivos: O tratamento endovascular de aneurismas intracranianos demonstra baixas taxas morbidade e mortalidade, entretanto, aneurismas complexos e de colo largo permanecem um desafio terapêutico. O objetivo deste estudo é avaliar o manejo endovascular de uma série de aneurismas intracranianos utilizando-se a técnica de remodelagem com balão.Método: Realizou-se uma avaliação retrospectiva de pacientes com aneurismas intracranianos submetidos a tratamento endovascular com a técnica de remodelagem com balão no Instituto de Neurologia de Curitiba (Outubro de 2006 a Junho de 2011).Resultados: Foram analisados 34 pacientes. A média de idade era de 55,12 anos e 78,79% eram do sexo feminino. Treze pacientes apresentavam aneurismas rotos (38,24%) e em 8 havia vasoespasmo (23,53%). A maioria dos aneurismas (61,76%) tinham entre 5-15 mm de tamanho e 41,18% apresentavam colo maior ou igual a 4 mm. Uma oclusão total foi obtida em 29 aneurismas (85,29%) e parcial em 2 neurismas (5,88%). Ocorreu óbito por hemorragia subaracnóidea relacionada ao procedimento em 1 caso.Conclusão: O tratamento endovascular com a técnica de remodelagem com balão mostra-se segura e eficaz para o tratamento de aneurismas intracranianos, especialmente naqueles complexos e com colo largo.
demonstrates low rates of morbidity and mortality. However,aneurysms with complex forms and wide neck remain atherapeutic challenge. The aim of this study is to evaluatethe endovascular management of a series of intracranialaneurysms using the balloon remodeling technique.Method: A retrospective evaluation was performed on patientswith intracranial aneurysms having undergone endovasculartreatment with balloon remodeling technique at the Institutode Neurologia de Curitiba (from October, 2006 to June, 2011).Results: Thirty-four patients were evaluated. The mean agewas 55.12 years and 78.79% were female. Thirteen patientshad ruptured aneurysms (38.24%) and 8 had vasospasm(23,53%). The majority of the aneurysms (61.76%) had domemeasurements between 5 to 15mm and 41.18% had a neck sizeof greater than or equal to 4mm. Total occlusion was obtainedin 29 aneurysms (85,29%) and partial occlusion in 2 (5.88%).One patient died from a procedure-related hemorrhage.Conclusion: Endovascular treatment with balloon remodelingtechniques seems to be a safe and effective treatment forintracranial aneurysms, especially those with complex formsand wide neck.
Subject(s)
Intracranial Aneurysm , Retrospective Studies , Subarachnoid HemorrhageABSTRACT
De acordo com sua localização, o tratamento cirúrgico dosmeningiomas intracranianos pode ser de grande desafio para oneurocirurgião. A aplicação de neuronavegação na ressecçãode meningiomas é comumente relacionada à localizaçãodo tumor, no entanto, este conceito é válido apenas para aslesões localizadas na convexidade. O uso da navegação podevariar desde a localização da craniotomia até a localizaçãode fibras da substância branca, áreas eloquentes e estruturasneurovasculares durante a ressecão de tumoração profunda.Em alguns casos, a neuronavegação pode não ser essencial,mas, se disponível, pode promover uma maior segurançaao tratamento cirúrgico. O objetivo deste artigo é mostrarcomo aprimorar o uso da neuronavegação para cirurgias demeningiomas intracranianos.
