Caregiver burden, hopelessness, and anxiety: Association between sociodemographic and clinical profiles of patients with stroke.

OBJECTIVES: This study aimed to evaluate the association between the sociodemographic characteristics of caregivers and patients with stroke, clinical data on stroke, and disability with caregiver burden, hopelessness, and anxiety. MATERIALS AND METHODS: This cross-sectional study included patients with stroke of either sex, aged >18 years. Data were collected between January 2020 and July 2021. Patient demographic included age, sex, stroke type, severity, etiology, topography, treatment, and stroke recurrence. Stroke disability was assessed using the modified Rankin Scale and Barthel Index at 90 days post-discharge. Additionally, caregiver burden, hopelessness, and anxiety were evaluated during patient consultations using the Zarit Burden Interview (ZBI), Beck Hopelessness Scale (BHS), and Beck Anxiety Inventory (BAI). RESULTS: We included 104 patients with stroke and their caregivers. Overall caregiver burden was moderate (ZBI: 24 [25]), with mild hopelessness (BHS: 4 [4]) and minimal to mild anxiety (BAI: 8 [13]). The linear regression model presented in Table 3 showed that female caregivers scored up to 11 points higher on the Zarit Burden Interview (p = 0.011). Additionally, increased patient age was associated with a higher caregiver burden (p = 0.002) on the Zarit Burden Interview. Posterior circulation stroke and total anterior circulation stroke were also associated with higher Zarit Burden Interview scores compared to lacunar stroke (p = 0.017). Age was not associated with caregiver burden in the entire sample. However, an association between age and caregiver burden was found only in the female group. Furthermore, women aged 65 years and older experienced a more severe burden than women aged 18 to 64 years (p<0.001). Stroke disability was not associated with caregiver burden. CONCLUSIONS: Older female caregivers were significantly affected when caring for stroke patients. Total anterior circulation stroke and Posterior circulation stroke increased Zarit Burden Interview scores. However, no association was observed between stroke disability and the caregiver burden.

Microsurgical Treatment of Anterior Communicating Artery Aneurysms: An Analysis of 74 Consecutive Cases. Approach Side Choice and Outcome Considerations / Tratamento microcirúrgico de aneurismas da artéria comunicante anterior: Uma análise de 74 casos consecutivos. Escolha da abordagem e considerações sobre resultados

Introduction Anterior communicating artery aneurysms (ACoAAs) are intracranial aneurysms whose treatment is still considered a challenging task. Materials and Methods Altogether, 74 patients were included in this study. The variables included age, sex, comorbidities, incidence of subarachnoid hemorrhage (SAH), the Fisher, Hunt-Hess, and WFNS scores, approach side, length of hospital stay, and mortality. We also investigate A1/A2 dimensions, association with approach side choice and the influence of surgeon's experience on the outcome. Results There were 61 patients (82.2%) admitted with SAH and 13 were treated for unruptured aneurysms. The A1 and A2 branches were larger ipsilaterally to the selected approach side (p < 0,001). No deaths occurred in the unruptured aneurysm group. In the SAH group, mortality was strongly correlated with the Hunt-Hess score (p < 0.001), Fisher grade (p < 0.001), and WFNS score (p < 0.001). No significant difference was found in mortality between the right-side and the left-side approaches (p » 0.253). A significant survival difference was identified on the group operated by the senior surgeon versus the non-senior group (p » 0.048). Discussion and Conclusion A1 dominance was identified as a factor associated to the approach side for SAH cases at our center. Understanding the factors involved in brain aneurysm surgery remains a relevant and underexplored subject. Further studies involving larger case series and multicenter collaborations are necessary to elucidate these factors and to determine the external validity of our findings.

Introdução Os aneurismas da artéria comunicante anterior (ACoAA) são aneurismas intracranianos cujo tratamento ainda é considerado uma tarefa desafiadora. Materiais e Métodos Ao todo, 74 pacientes foram incluídos neste estudo. As variáveis incluíram idade, sexo, comorbidades, incidência de hemorragia subaracnóidea (HAS), escala de Fisher, Hunt-Hess e WFNS, lado de abordagem, tempo de internação e mortalidade. Também investigamos as dimensões A1/A2, a associação com a escolha do lado de abordagem e a influência da experiência do cirurgião no resultado. Resultados Foram admitidos 61 pacientes (82,2%) com HAS e 13 foram tratados por aneurismas não rotos. Os ramos A1 e A2 foram maiores ipsilateralmente ao lado de abordagem selecionada (p < 0,001). Nenhuma morte ocorreu no grupo de aneurismas não rotos. No grupo HAS, a mortalidade esteve fortemente correlacionada com a escala de Hunt-Hess (p < 0,001), pontuação de Fisher (p < 0,001) e pontuação WFNS (p < 0,001). Não foi encontrada diferença significativa na mortalidade entre as abordagens direita e esquerda (p » 0,253). Foi identificada diferença significativa de sobrevida no grupo operado pelo cirurgião sênior versus o grupo não sênior (p » 0,048). Discussão e Conclusão A dominância A1 foi identificada como fator associado ao lado de abordagem dos casos de HAS em nosso centro. A compreensão dos fatores envolvidos na cirurgia de aneurisma cerebral permanece um assunto relevante e pouco explorado. Mais estudos envolvendo séries de casos maiores e colaborações multicêntricas são necessários para elucidar esses fatores e para determinar a validade externa de nossas descobertas.

Factors Related to the Recurrence of Low-grade Gliomas / Fatores relacionados à recorrência dos gliomas de baixo grau

Objective To identify the determining factors for reoperation in patients with low-grade gliomas, taking into account the degree of resection, and to analyze the histological aspects, observing possible transformations with signs of malignancy in the tissue samples. Materials and Methods The sample consisted of 40 cases of low-grade glioma that were operated on at Hospital das Clínicas de Botucatu between 2013 and 2019. Results The mean follow-up was of 37 months, and the sample was composed of 28 men and 12 women with a mean age at the first surgery of 43.1 15.6 years. Epileptic seizures were observed in 31 (77.5%) patients. According to the histological classification, half of the patients presented oligodendroglioma (50%), of grade II in most cases (97.5%). Total or subtotal resection was achieved in 22 (55%) patients. Only one patient underwent radiotherapy, and two underwent chemotherapy. Reoperation was performed in 20 (50%) patients. The median interval between the first surgery and the reapproach was of 16 (range: 0­77) months. In the second approach, the histological classification was of astrocytoma in 4 (20%) cases, oligoastrocytoma in another 4 (20%), oligodendroglioma in 7 (35%), and glioblastoma in 5 (25%) cases. The only variable associated with the need for reoperation was the degree of resection after the first surgery (p » 0.013). Conclusions Total resection of low-grade gliomas, when feasible, should be performed to avoid recurrence.

Objetivo Apontar os fatores determinantes para a reoperação em pacientes com gliomas de baixo grau considerando o grau de ressecção, e analisar os aspectos histológicos, observando possíveis transformações com sinais de malignidade nas amostras teciduais estudadas. Materiais e Métodos A casuística foi composta por 40 casos de gliomas de baixo grau operados no Hospital das Clínicas de Botucatu de 2013 a 2019. Resultados O tempo médio de seguimento de foi de 37 meses, sendo a amostra composta de 28 homens e 12 mulheres com idade média à primeira cirurgia de 43,1 15,6 anos. Crises epilépticas foram observadas em 31 pacientes (77,5%). Na classificação histológica, a metade dos pacientes apresentou oligodendroglioma (50%), sendo de grau II na maioria dos casos (97,5%). Ressecção total ou subtotal foi atingida 22 pacientes (55%). Apenas um paciente foi submetido a radioterapia, e dois, a quimioterapia. Reoperação foi realizada em 20 pacientes (50%). O intervalo mediano entre a primeira cirurgia e a reabordagem foi de 16 (variação: 0­77) meses; na segunda abordagem, a classificação histológica foi de astrocitoma em 4 casos (20%), oligoastrocitoma em outros 4 (20%), oligodendroglioma em 7 casos (35%), e glioblastoma em 5 casos (25%). A única variável que apresentou associação com a necessidade de reoperação foi o grau de ressecção da primeira cirurgia (p » 0,013). Conclusão A ressecção total dos gliomas de baixo grau, quando factível, deve ser buscada com a finalidade de evitar a sua recorrência.

Risk Factors for Malfunction of Ventriculoperitoneal Shunts Performed by Medical Residents in Children: An Exploratory Study / Fatores de risco para disfunção de derivações ventrículo-peritoneais realizadas por médicos residentes em crianças: Estudo exploratório

Introduction Ventriculoperitoneal shunts (VPSs) are common neurosurgical procedures, and in educational centers, they are often performed by residents. However, shunts have high rates of malfunction due to obstruction and infection, especially in pediatric patients. Monitoring the outcomes of shunts performed by trainee neurosurgeons is important to incorporate optimal practices and avoid complications. Methods In the present study, we analyzed the malfunction rates of VPSs performed in children by residents as well as the risk factors for shunt malfunction. Results The study included 37 patients aged between 0 and 1.93 years old at the time of surgery. Congenital hydrocephalus was observed in 70.3% of the patients, while 29.7% showed acquired hydrocephalus. The malfunction rate was 54.1%, and the median time to dysfunction was 28 days. Infections occurred in 16.2% of the cases. Cerebrospinal fluid leukocyte number and glucose content sampled at the time of shunt insertion were significantly different between the groups (p » 0.013 and p » 0.007, respectively), but did not have a predictive value for shunt malfunction. In a multivariate analysis, the etiology of hydrocephalus (acquired) and the academic semester (1st) in which the surgery was performed were independently associated with lower shunt survival (p » 0.009 and p » 0.026, respectively). Conclusion Ventriculoperitoneal shunts performed in children by medical residents were at a higher risk of malfunction depending on the etiology of hydrocephalus and the academic semester in which the surgery was performed.

Introdução As derivações ventrículo-peritoneais (DVPs) são procedimentos neurocirúrgicos comuns e, em centros educacionais, muitas vezes são realizados por residentes. No entanto, os shunts apresentam altas taxas de mau funcionamento devido a obstrução e infecção, especialmente em pacientes pediátricos. O monitoramento dos resultados das válvulas realizadas por neurocirurgiões em treinamento é importante para incorporar as práticas ideais e evitar complicações. Métodos No presente estudo, analisamos as taxas de mau funcionamento de DVPs realizados em crianças por residentes, assim como os fatores de risco para mau funcionamento da válvula. Resultados O estudo incluiu 37 pacientes com idades entre 0 e 1,93 anos na época da cirurgia. Hidrocefalia congênita foi observada em 70,3% dos pacientes, enquanto 29,7% apresentaram hidrocefalia adquirida. A taxa de disfunção foi de 54,1% e o tempo médio para disfunção foi de 28 dias. Infecções ocorreram em 16,2% dos casos. O número de leucócitos do líquido cefalorraquidiano e o conteúdo de glicose coletados no momento da inserção da válvula foram significativamente diferentes entre os grupos (p » 0,013 e p » 0,007, respectivamente), mas não tiveram um valor preditivo para o mau funcionamento da válvula. Em uma análise multivariada, a etiologia da hidrocefalia (adquirida) e o semestre letivo (1°) em que a cirurgia foi realizada foram independentemente associados a menor sobrevida do shunt (p » 0,009 e p » 0,026, respectivamente). Conclusão: Derivações ventrículo-peritoneais realizadas em crianças por médicos residentes apresentaram maior risco de mau funcionamento dependendo da etiologia da hidrocefalia e do semestre letivo no qual a cirurgia foi realizada.