Prevención de las infecciones postoperatorias en neurocirugía / Prevention of postoperative infections in neurosurgery

Analizamos las infecciones postoperatorias en 866 pacientes. El lavado de campo operatorio se efectuó con clorhexidina y se inyectó cloxacilina profiláctica. Hubo 1 infección de la herida operatoria (0,1 por ciento). El tiempo de seguimiento fluctuó entre 9 meses y 4 años. El método mostró ser eficaz, sin casos de sobreinfección, alergia ni toxicidad sistémica, pero al no haber un control, no permite concluir que se debe usar ATB profilácticos en todos los pacientes neuroquirúrgicos. La situación epidemiológica es diferente en cada hospital, siendo el diagnóstico local fundamental en la elaboración de programas de prevención. Es necesario definir las cirugías con mayor riesgo de infecciones postoperatorias y los gérmenes más probables y según esto establecer el esquema ATB profiláctico

Paediatric neurosurgery in Trinidad and Tobago - abstract

Neurosurgery in childhood is a distinct branch of neurosurgery. All cases admitted to the paediatric section of the neurosurgical unit in the 5 years from July 1980 to June 1985 were studied retrospectively, to determine the disease pattern and outcome. There were 260 cases with even annual and sex distribution, 40 percent in their first year, 20 percent total newborn, and the rest below the age of 12 years. Eighteen were from other Caribbean territories. There were 214 cranial diagnosis, distributed as congenital, 72; head injury, 76 infection, 12; vascular, 4; tumours, 20, and other, 30. Significant were hydrocephalus, 51; encephalocele, 8; craniosynostosis, 6; depressed skull fracture, 25 acute subdural haematoma, 3; brain stem injury, 8, and cerebral abscess, 3. The tumours were brain stem astrocytoma, 6; cerebral astrocytoma, 5 medulloblastoma, 4; craniopharyngioma, 2, and one each of cerebellar astrocytoma, pineal tumour and ependymoma. There were 63 spinal diagnosis - congenital, 52; injury, 4; tumours, 3 and other, 4. Significant were mylomeningocele, 40, and, in tumours, one each of cervical meningioma, chondrosarcoma and neurofibroma. There were 160 surgical procedures - congenital, 92: trauma, 37:infection, 8: vascular, 2: tumours, 19, and others, 2. The most frequent procedures were ventriculo-atrial shunt, 27: ventriculo-peritoneal shunt, 25; shunt revisions, 36; encephalocele repairs, 8; craniosynostosis, 5; release, 3 craniotomies for acute subdural haematoma, 21 fracture elevations, 10 exploratory burr holes, 3 cerebral abscess evacuation, and for tumours, 4 craniotomies, 4 posterior fossa explorations and 7 shunts. In the spinal group, there were 33 myelomeningocele repairs and a cervical meningioma, chondrosarcoma and neurofibroma were removed. Ther were 33 deaths; 21 of these had had surgical procedures. In the total group, 10 were related to congenital defects, 12 were severe head injury, 2 meningitis, 2 ruptured intra-cranial bascular lesions and 6 tumours. The following pertinent factors emerged: neural tube defects were noted in the East-Indian in the East-West corridor and Changuanas and in the Afro-Trinidadian in the Belmont-Laventille area. The ventriculoatrial shunt seemed preferable to ventriculo-peritoneal, and the use of 2 separate shunt systems in recurrently malfunctioning shunts was a successful new approach. Head injuries were common and the survival rate unexpectedly good. Spinal fractures were uncommon. Infection had a good prognosis but paediatric brain tumours presented the same dismal picture as it does worldwide (AU)

Infeccoes em neurocirurgia. / Infections in neurosurgery

Baseado em 733 cirurgias neurologicas realizadas em um periodo de 50 meses o autor expoe as providencias tomadas para conter o surto infeccioso.Alteracoes de tecnica de antissepsia e tatica cirurgica foram levadas a efeito durante os tres periodos de duracao do estudo. Nas duas primeiras etapas, de l7 meses cada uma, a incidencia de infeccao em cirurgias limpas foi de 10,3 e 6,7%. Na ultima etapa de 15 meses, quando se associou o uso de antibiotico topico (oxalina em po), este indice caiu para 0,6%.As taxas gerais de infeccao para os tres periodos, somando-se as cirurgias limpas, limpas com implantes, limpas contaminadas e contaminadas foi de 7,08%, 6,8 e 3,4%, respectivamente. Uma revisao sumaria dos dados de literatura referentes a antibioticoterapia profilatica sistemica e topica antecedem os comentarios sobre as bases da mudanca de tecnica efetuadas durante o estudo Tricotomia proxima a operacao, adocao de tecnica seca para a preparacao do retalho da pele e musculatura, uso exclusivo do coagulador bipolar, uso restrito de soro epidural, e uso de oxacilina em po antes do fechamento foram os itens principais das modificacoes realizadas

Neurocirugía básica

Conocimientos básicos de neurocirugía, procesos encefalocraneanos, medulorraquídeos y de los nervios perifericos: patología, clínica, recursos, diagnósticos, tratamiento y pronóstico. Hipertensión endocránea, procesos ocupantes intracraneales y traumatismos craneoencefálicos. Hidrocefalia, epilepsia quirúrgica, procesos vasculares encefálicos. Compresión y traumatismo raquimedulares. Hernia de disco. Lesiones de los nervios periféricos. Dolor rebelde. Malformaciones y anomalias del desarrollo. Función raquídea, electro y encefalograma, electrodiagnóstico de estimulación. Radiografía de craneo. Angia, neumo centellografia. Mielografía

Neurocirugía básica

Conocimientos básicos de neurocirugía, procesos encefalocraneanos, medulorraquídeos y de los nervios perifericos: patología, clínica, recursos, diagnósticos, tratamiento y pronóstico. Hipertensión endocránea, procesos ocupantes intracraneales y traumatismos craneoencefálicos. Hidrocefalia, epilepsia quirúrgica, procesos vasculares encefálicos. Compresión y traumatismo raquimedulares. Hernia de disco. Lesiones de los nervios periféricos. Dolor rebelde. Malformaciones y anomalias del desarrollo. Función raquídea, electro y encefalograma, electrodiagnóstico de estimulación. Radiografía de craneo. Angia, neumo centellografia. Mielografía