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BACKGROUND: Surgical timing after rupture of brain arteriovenous malformations (AVMs) is controversial. There is scarce literature on AVM surgical outcomes from developing countries. This study aims to determine if there is a difference between early and delayed surgical resection for patients with ruptured brain AVMs. METHODS: This single-center retrospective review included patients who underwent surgical resection for ruptured brain AVMs in Colombia. Patients were stratified by the timing of surgical intervention relative to the rupture into early (≤72 hours of bleeding) and delayed (>72 hours) resection. Continuous variables were analyzed using an independent t-test, and dichotomous variables were analyzed using a χ2 test. A linear regression analysis was performed with the final mRankin score at 2 years as the dependent variable; P < 0.05 was considered significant. RESULTS: Thirty-one patients were identified. The early treatment group included 14 (45.2%) patients, and the delayed group included 17 (54.8%) patients. The mean (SD) length of time between AVM rupture and surgical resection was 1.6 ± 1.2 days and 12.4 ± 8.4 days, respectively (P < 0.001). There were no differences regarding demographics, perioperative variables, and postoperative outcomes between groups. In the linear regression analysis, the only variable that had a significant association with the final mRankin score was the initial Glasgow Coma Scale, which had a ß coefficient of -0.6341 (95% confidence interval: -0.41,-0.017, P = 0.035). CONCLUSIONS: In this case series of 31 patients from a developing country, there were no differences in clinical outcomes at the final follow-up between acute and delayed surgical interventions for ruptured AVMs. The most important factor associated with the final outcomes was the initial Glasgow Coma Scale.
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RESUMEN Introducción: La lobectomía temporal anterior (LTA) es un procedimiento quirúrgico comúnmente utilizado para el tratamiento de la epilepsia del lóbulo temporal refractario al tratamiento médico, con altas tasas de éxito en el control de las crisis. Sin embargo, se ha descrito una asociación importante con enfermedades psiquiátricas que puede afectar al resultado posquirúrgico en estos pacientes. Métodos: Se exponen 2 casos representativos de pacientes que sufrieron complicaciones psiquiátricas en el posoperatorio de lobectomía temporal anterior, a pesar del control exitoso de las crisis. Resultados: Un varón sin antecedentes de enfermedad mental que sufre un episodio depresivo mayor en el periodo posoperatorio mediato, y una mujer con psicosis previa que evidencia exacerbación de su afección como complicación quirúrgica. Conclusiones: La enfermedad psiquiátrica se puede presentar en pacientes posoperatorios de epilepsia de lóbulo temporal tanto con antecedentes de enfermedad mental como sin ellos. Las alteraciones más frecuentes reportadas son depresión, ansiedad, psicosis y trastornos de la personalidad. La inclusión de evaluaciones psiquiátricas en los protocolos prequirúrgicos y posquirúrgicos pueden llevar a una mejora en el pronóstico de los resultados neurológicos y mentales de los pacientes sometidos a la intervención.
ABSTRACT Introduction: Anterior temporal lobectomy (LTA) is a surgical procedure commonly used for the treatment of temporal lobe epilepsy refractory to medical management, with high success rates in the control of seizures. However, an important association with psychiatric illnesses has been described that can alter the postoperative outcome in these patients. Methods: A series of 2 cases of patients who, despite successful crisis control, developed psychiatric complications in the postoperative period of anterior temporal lobectomy. Results: The cases included a male patient with no history of previous mental illness, who developed a major depressive episode in the postoperative period, and a female patient with previous psychosis who presented as a surgical complication exacerbation of psychosis, diagnosed with paranoid schizophrenia. Conclusions: Psychiatric disorders can occur in postoperative temporal lobe epilepsy patients with or without a history of mental illness. The most frequent alterations reported are depression, anxiety, psychosis and personality disorders. The inclusion of psychiatric evaluations in the pre- and post-surgical protocols can lead to an improvement in the prognosis of the neurological and mental outcomes of the patients undergoing the intervention.
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INTRODUCTION: Anterior temporal lobectomy (LTA) is a surgical procedure commonly used for the treatment of temporal lobe epilepsy refractory to medical management, with high success rates in the control of seizures. However, an important association with psychiatric illnesses has been described that can alter the postoperative outcome in these patients. METHODS: A series of 2 cases of patients who, despite successful crisis control, developed psychiatric complications in the postoperative period of anterior temporal lobectomy. RESULTS: The cases included a male patient with no history of previous mental illness, who developed a major depressive episode in the postoperative period, and a female patient with previous psychosis who presented as a surgical complication exacerbation of psychosis, diagnosed with paranoid schizophrenia. CONCLUSIONS: Psychiatric disorders can occur in postoperative temporal lobe epilepsy patients with or without a history of mental illness. The most frequent alterations reported are depression, anxiety, psychosis and personality disorders. The inclusion of psychiatric evaluations in the pre- and post-surgical protocols can lead to an improvement in the prognosis of the neurological and mental outcomes of the patients undergoing the intervention.
Assuntos
Transtorno Depressivo Maior , Psicocirurgia , Lobectomia Temporal Anterior/efeitos adversos , Transtorno Depressivo Maior/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Resultado do TratamentoRESUMO
INTRODUCTION: Anterior temporal lobectomy (LTA) is a surgical procedure commonly used for the treatment of temporal lobe epilepsy refractory to medical management, with high success rates in the control of seizures. However, an important association with psychiatric illnesses has been described that can alter the postoperative outcome in these patients. METHODS: A series of 2 cases of patients who, despite successful crisis control, developed psychiatric complications in the postoperative period of anterior temporal lobectomy. RESULTS: The cases included a male patient with no history of previous mental illness, who developed a major depressive episode in the postoperative period, and a female patient with previous psychosis who presented as a surgical complication exacerbation of psychosis, diagnosed with paranoid schizophrenia. CONCLUSIONS: Psychiatric disorders can occur in postoperative temporal lobe epilepsy patients with or without a history of mental illness. The most frequent alterations reported are depression, anxiety, psychosis and personality disorders. The inclusion of psychiatric evaluations in the pre- and post-surgical protocols can lead to an improvement in the prognosis of the neurological and mental outcomes of the patients undergoing the intervention.