RESUMO
OBJECTIVE: To define and grade neurosurgical and spinal postoperative complications based on their need for treatment. METHODS: Complications were defined as any deviation from the normal postoperative course occurring within 30 days of surgery. A four-grade scale was proposed based on the therapy used to treat the complications: grade I, any non-life-threatening complications treated without invasive procedures; grade II, complications requiring invasive management such as surgical, endoscopic, and endovascular procedures; grade III, life-threatening adverse events requiring treatment in an intensive care unit (ICU); and grade IV, deaths as a result of complications. Each grade was classified as a surgical or medical complication. An observational test of this system was conducted between January 2008 and December 2009 in a cohort of 1190 patients at the Hospital Italiano de Buenos Aires. RESULTS: Of 167 complications, 129 (10.84%) were classified as surgical, and 38 (3.19%) were classified as medical complications. Grade I (mild) complications accounted for 31.73%, grade II (moderate) complications accounted for 25.74%, and grade III (severe) complications accounted for 34.13%. The overall mortality rate was 1.17%; 0.84% of deaths were directly related to surgical procedures. CONCLUSIONS: The authors present a simple, practical, and easy to reproduce way to report negative outcomes based on the therapy administered to treat a complication. The main advantages of this classification are the ability to compare surgical results among different centers and times, the ability to compare medical and surgical complications, and the ability to perform future meta-analyses.
Assuntos
Neurocirurgia/classificação , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/classificação , Anestesia , Argentina/epidemiologia , Encéfalo/cirurgia , Estudos de Coortes , Cuidados Críticos , Humanos , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Reoperação , Medula Espinal/cirurgia , Coluna Vertebral/cirurgia , Resultado do TratamentoRESUMO
Introduction. Surgical treatment of trigeminal neuralgia remains a matter of debate since there are no studies comparing long term effectiveness of the different surgical techniques. We present our 10 year experience. Description. Series: 40 patients. Period: 1998 - 2008. Surgical techniques: microvascular decompression, radiofrequency thermorhizotomy and balloon compression. Analyzed parameters: age, sex, nerve root involved, pain relief, recurrence, complications, need to restart medication and reintervention. Discussion. Microvascular decompression offers better long term results, radiofrequency is adequate for special cases (higher recurrence rate), and balloon compression is better for V1 neuralgia. Our sample is too small for statistics, yet our findings are coincident with the literature. Conclusion. Better patient selection criteria for each technique are needed. Microvascular decompression should be the treatment of choice when possible. How to treat recurrence remains unanswered.
Assuntos
Microcirurgia , Neurofisiologia , Neuralgia do Trigêmeo/cirurgia , Neuralgia do TrigêmeoRESUMO
Clasificación histológica de los tumores del sistema nervioso central, de acuerdo con la OMS. Nuevos criterios sobre tumores del sistema nervioso en niños. Descripción anatomopatológica de los tumores del sistema nervioso central. Ordenamiento de los tumores endocraneales por frecuencia e incidencia, de acuerdo a edad, sexo y localización. Consideraciones generales sobre el diagnóstico por imágenes de los tumores endocraneales. Estadística de los 765 tumores endocraneales estudiados por tomografía computada, resonancia nuclear magnética, cirugía y anatomía patológica. Descripción de las imágenes de los principales tumores del sistema nervioso central. Biopsia cerebral, guiada por tomografía computada
Assuntos
Humanos , Criança , Adulto , Astrocitoma/ultraestrutura , Biópsia por Agulha/métodos , Craniofaringioma/ultraestrutura , Ependimoma/ultraestrutura , Espectroscopia de Ressonância Magnética , Glioblastoma/ultraestrutura , Meduloblastoma/ultraestrutura , Neoplasias Encefálicas/diagnóstico , Neoplasias do Sistema Nervoso/classificação , Oligodendroglioma/ultraestrutura , Tomografia Computadorizada por Raios X/métodos , Colesteatoma/ultraestrutura , Diagnóstico por Imagem/métodos , Espectroscopia de Ressonância Magnética/métodos , Hemangioendotelioma/ultraestrutura , Meningioma/ultraestrutura , Metástase Neoplásica , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/secundário , Neoplasias Hipofisárias/classificação , Neoplasias Hipofisárias/ultraestrutura , Neurilemoma/ultraestrutura , Neuroblastoma , Recidiva Local de Neoplasia , Tomografia Computadorizada por Raios X/métodosRESUMO
Clasificación histológica de los tumores del sistema nervioso central, de acuerdo con la OMS. Nuevos criterios sobre tumores del sistema nervioso en niños. Descripción anatomopatológica de los tumores del sistema nervioso central. Ordenamiento de los tumores endocraneales por frecuencia e incidencia, de acuerdo a edad, sexo y localización. Consideraciones generales sobre el diagnóstico por imágenes de los tumores endocraneales. Estadística de los 765 tumores endocraneales estudiados por tomografía computada, resonancia nuclear magnética, cirugía y anatomía patológica. Descripción de las imágenes de los principales tumores del sistema nervioso central. Biopsia cerebral, guiada por tomografía computada
