ABSTRACT
INTRODUCTION: Transcorporeal anterior cervical microforaminotomy is a motion-preserving surgery. It addresses directly to the prolapsed disc in contrast to posterior laminoforaminotomy and does not affect facet joints; in the transuncal approach, there is a chance of vertebral artery injury and it also decreases disc height; hence, may alter the motion of that segment. OBJECTIVE: Aim is to assess the outcome of surgery and its effectiveness. METHODS: A total of 40 patients were observed retrospectively of which 33 were male and 7 were female. A single study of transcorporeal anterior cervical microforaminotomy was analyzed in a private hospital (Comfort Hospital), Dhaka, Bangladesh. Patients having pure brachialgia who were not relieved by conservative treatment over 6-8 weeks in cervical disc prolapse were included in the study. Patients having more than one level of disease, features of myelopathy, or instability were excluded from the study. RESULTS: All patients were pain-free postoperatively, although after one to two months 2 out of 40 patients developed brachialgia and required anterior cervical discectomy and fusion. CONCLUSION: Transcorporeal microforaminotomy for brachialgia is a safe and effective approach that is motion preserving and minimally invasive as well.
Subject(s)
Intervertebral Disc Displacement , Spinal Fusion , Bangladesh , Cervical Vertebrae/surgery , Diskectomy , Female , Humans , Intervertebral Disc Displacement/surgery , Male , Retrospective Studies , Treatment OutcomeSubject(s)
Intracranial Aneurysm , Stroke , France/epidemiology , Humans , Intracranial Aneurysm/surgeryABSTRACT
INTRODUCTION: The term «gossypiboma¼ comes from the Latin gossypium, which refers to a genus of cotton plants, and from the Swahili word boma, which translates as «place of concealment¼. It may be mistaken for tumorous lesions or abscesses due to the way it is encapsulated, as evidenced in imaging examinations, and its variable and non-specific clinical features, which give rise to difficulty in its diagnosis and significant morbidity. AIM: To synthesise the available evidence on the presence of gossypibomas during neurosurgical procedures. DEVELOPMENT: A review was performed that included a search for articles in English and Spanish published in the last 15 years in PubMed, Ebsco Host, Embase, Mediclatina, Cochrane, Lilacs and Scopus, between January and June 2019, using the keywords «gossypiboma¼, «textiloma¼, «neurosurgery¼ and «neurosurgical procedures¼. In all, a total of 630 articles were found in the search, although, after selecting them by title and abstract, 22 case report articles were included for this review process. Altogether 36 individuals were identified, of whom 21 (58.3%) were women, and whose mean age was 56.1 years. Surgical sponges were observed as gossypibomas in 20 cases (55.6%). CONCLUSIONS: Gossypiboma is a complication secondary to surgical procedures that presents fairly unspecific signs and symptoms. The time that elapses before it appears usually ranges from a few days to several years after surgery and is correlated with multiple medical and legal implications.
TITLE: Gossypibomas en neurocirugía.Introducción. El término «gossypiboma¼ proviene del latín gossypium, que hace referencia a un género de plantas de algodón, y de la palabra kiswahili boma, que se traduce como «lugar de escondite¼. Puede confundirse con lesiones tumorales o abscesos debido a la forma de encapsulación evidenciada en los exámenes imaginológicos y su clínica variable e inespecífica, situación que genera dificultad para el diagnóstico y una morbilidad importante. Objetivo. Sintetizar la evidencia disponible sobre la presencia de gossypibomas durante la realización de procedimientos quirúrgicos en neurocirugía. Desarrollo. Se realizó una revisión en la cual se incluyó una búsqueda de artículos en inglés y castellano publicados en los últimos 15 años en PubMed, Ebsco Host, Embase, Mediclatina, Cochrane, Lilacs y Scopus, entre enero y junio de 2019, utilizando las palabras clave «gossypiboma¼, «textiloma¼, «neurosurgery¼ y «neurosurgical procedures¼. El total de artículos encontrados en la búsqueda fue de 630; sin embargo, tras la selección por título y resumen fueron 22 los artículos de informe de caso que se incluyeron. Se identificó a un total de 36 individuos, de los cuales 21 (58,3%) eran mujeres, y cuya edad media era de 56,1 años. En 20 casos (55,6%) se observaron esponjas quirúrgicas como gossypibomas. Conclusiones. El gossypiboma es una complicación secundaria a procedimientos quirúrgicos, con signos y síntomas bastante inespecíficos. Su tiempo de aparición suele oscilar entre unos cuantos días hasta varios años después de realizada la cirugía y se correlaciona con múltiples implicaciones médicas y legales.
Subject(s)
Foreign Bodies , Neurosurgical Procedures , Adult , Aged , Aged, 80 and over , Female , Foreign Bodies/diagnosis , Foreign Bodies/epidemiology , Foreign Bodies/etiology , Humans , Male , Middle Aged , Young AdultSubject(s)
Neuroimaging/methods , Subarachnoid Hemorrhage/diagnostic imaging , Subarachnoid Hemorrhage/diagnosis , Angiography, Digital Subtraction , Computed Tomography Angiography , Headache Disorders, Primary/diagnosis , Headache Disorders, Primary/etiology , Humans , Magnetic Resonance Angiography , Subarachnoid Hemorrhage/therapy , Subarachnoid Hemorrhage, Traumatic/diagnosis , Subarachnoid Hemorrhage, Traumatic/diagnostic imaging , Subarachnoid Hemorrhage, Traumatic/therapy , Tomography, X-Ray Computed , Treatment Outcome , Ultrasonography, Doppler, TranscranialABSTRACT
TITLE: Interacciones potenciales con ivermectina como tratamiento coadyuvante en la epilepsia refractaria.
Subject(s)
Drug Resistant Epilepsy , Ivermectin , Combined Modality Therapy , Epilepsy , HumansABSTRACT
INTRODUCTION: External lumbar drainage is a promising measure for the prevention of delayed aneurysmal subarachnoid hemorrhage-related ischemic complications. METHODS: Controlled studies evaluating the effects of external lumbar drainage in patients with aneurysmal subarachnoid hemorrhage were included. Primary outcomes were: new cerebral infarctions and severe disability. Secondary outcomes were: clinical deterioration due to delayed cerebral ischemia, mortality, and the need of definitive ventricular shunting. Results were presented as pooled relative risks, with their 95% confidence intervals (95% CI). RESULTS: A total of 6 controlled studies were included. Pooled relative risks were: new cerebral infarctions, 0.48 (95% CI: 0.32-0.72); severe disability, 0.5 (95% CI: 0.29-0.85); delayed cerebral ischemia-related clinical deterioration, 0.46 (95% CI: 0.34-0.63); mortality, 0.71 (95% CI: 0.24-2.06), and need of definitive ventricular shunting, 0.80 (95% CI: 0.51-1.24). Assessment of heterogeneity only revealed statistically significant indexes for the analysis of severe disability (I(2)=70% and P=.01). CONCLUSION: External lumbar drainage was associated with a statistically significant decrease in the risk of delayed cerebral ischemia-related complications (cerebral infarctions and clinical deterioration), as well as the risk of severe disability; however, it was not translated in a lower mortality. Nevertheless, it is not prudent to provide definitive recommendations at this time because of the qualitative and quantitative heterogeneity among included studies. More randomized controlled trials with more homogeneous outcomes and definitions are needed to clarify its impact in patients with aneurysmal subarachnoid hemorrhage.
Subject(s)
Cerebrospinal Fluid , Subarachnoid Hemorrhage/cerebrospinal fluid , Subarachnoid Hemorrhage/therapy , Suction/methods , Brain Ischemia/etiology , Brain Ischemia/prevention & control , Humans , Randomized Controlled Trials as Topic , Subarachnoid Hemorrhage/complicationsABSTRACT
OBJECTIVE: To determine the effects of applying vancomycin powder within the surgical wound on the risk of surgical infections, pseudo-arthrosis and adverse events, in patients undergoing spinal surgery. MATERIAL AND METHODS: A meta-analysis was carried out, including controlled studies that evaluated the risk of postoperative infections and/or pseudo-arthrosis in patients undergoing spinal surgery in which vancomycin powder was applied within the surgical wound. RESULTS: were presented as pooled relative risks, with its 95% confidence intervals. Additionally, the frequency of complications attributable to vancomycin was also assessed. RESULTS: A total of six controlled studies (3,379 subjects) were included. Pooled relative risks were: surgical site infection, 0.11 (95%CI: 0.05-0.25; P<.00001), and pseudo-arthrosis, 0.87 (95%CI; 0.34-2.21; P=.77). No statistically significant heterogeneity was found in both analyses. In 1,437 patients treated with vancomycin, there were no recorded vancomycin-related adverse events. CONCLUSIONS: Application of vancomycin powder into the wound was associated with a significantly reduced risk of surgical site infections, without increasing pseudo-arthrosis or adverse events. However, randomized controlled trials are needed, in order to confirm the present results and make recommendations with more certainty.
