Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 8 de 8
Filtrar
Mais filtros










Intervalo de ano de publicação
1.
World Neurosurg ; 145: e274-e277, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33065345

RESUMO

OBJECTIVE: Although chronic subdural hematomas (cSDH) are often treated surgically it remains plausible that invasive treatment in elderly patients may have a negative effect on survival. The aim of this study was to characterize survival following neurosurgical intervention for cSDH in a selected cohort aged >90 years and to identify prognostic factors that may inform clinical decision-making. METHODS: In total, we identified a cohort of 548 consecutive patients who had undergone burr hole drainage for cSDH in a 5-year period between 2009-2013. Of these patients, 41 were aged >90 years. For each patient, information was gathered from local hospital records, general practice records, and the patients directly. Long-term survival was compared with actuarial data obtained from the National Life Tables. RESULTS: Overall mortality at the time of discharge was 2%. Mortality was 26.8% at 6 months, 36.8% at 1 year, and 47.9% at 2 years. Interestingly, there was no significant difference between the actuarial curve and the survival curve following surgery (hazard ratio, 1.17; confidence interval, 0.67-2.05; P = 0.57). Despite initially departing from the actuarial curve, the survival curve becomes parallel at approximately 1 year. Multivariate analysis showed that preadmission residence and the number of comorbid conditions were significant predictors of survival. CONCLUSIONS: We advocate that neurosurgical intervention for cSDH in selected nonagenarians can be a safe and beneficial procedure. Patients living independently at home and with a limited past medical history were most likely to benefit from the surgery.


Assuntos
Hematoma Subdural Crônico/mortalidade , Hematoma Subdural Crônico/cirurgia , Trepanação/mortalidade , Trepanação/métodos , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino
2.
World Neurosurg ; 132: e812-e819, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31404689

RESUMO

BACKGROUND: Few reports have focused on chronic subdural hematoma (CSDH) in the very elderly, who have lived beyond average life expectancy. Our aim is to appraise treatment outcomes of burr-hole craniotomy for CSDH in the elderly, focusing on cure, recurrence, and complications. METHODS: Fifty patients ≤79 years of age (group A) and 73 patients ≥80 years of age (group B) were studied. Recurrence was defined as requiring reoperation for hematoma regrowth or symptomatic failure. A cure was regarded as having been achieved in the absence of hematoma on postoperative computed tomography. Complications were defined as any harmful event related to the treatment procedure for CSDH. RESULTS: Cure was documented in 31 patients in group A (63%) and 24 patients in group B (33%) (P = 0.0017). Median intervals to cure were 2.76 and 3.73 months, respectively (P = 0.06). Cumulative cure rates were 51%/76% and 36%/59%, respectively, at the sixth/twelfth postoperative months. Recurrence was documented in 2 patients (4%) and 11 patients (15%), respectively (P = 0.07). Median intervals to recurrence were 0.81 and 1.25 months, respectively (P = 0.049). Cumulative recurrence-free rates were 96%/92% and 87%/75%, respectively, at the third/sixth postoperative months. Complications were observed in 2 patients (4%) and 4 patients (5%), respectively (P = 1.00). CONCLUSIONS: With advancing age, CSDH might show a greater tendency to recur and a longer time is required to achieve a cure. However, complications developed only in high-risk patients. Thus, surgical treatment for CSDH in elderly patients, even those who have lived beyond life expectancy, might provide acceptably effective results.


Assuntos
Hematoma Subdural Crônico/cirurgia , Trepanação/métodos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Hematoma Subdural Crônico/mortalidade , Humanos , Estimativa de Kaplan-Meier , Expectativa de Vida , Masculino , Complicações Pós-Operatórias/epidemiologia , Recidiva , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento , Trepanação/mortalidade
3.
World Neurosurg ; 113: 78-81, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29454127

RESUMO

Trepanation is one of the most ancient and applied surgical treatments; several archaeologically documented cases are known, dated back from prehistory to the Middle Ages. This case study reports the anthropologic analysis of the skeletal remains of a young medieval woman and a fetus (Imola, Italy). The fetal remains were laid between her pelvis and lower limbs. A perforating injury was observed to her frontal bone. After assessing biologic profiles, we attempted to interpret the injury and to reconstruct possible circumstances of death. The lesion seems commensurate with a surgical intervention; signs of an osteogenic reaction were detected at its edges. It can be hypothesized that the survival of the woman undergoing the surgery was approximately 1 week and the fetus extruded after the burial. Thus, this case represents a unicum, spreading more light on the history of neurosurgery during the Early Middle Ages in Europe.


Assuntos
Complicações na Gravidez/história , Trepanação/história , Causas de Morte , Feminino , Morte Fetal , História Medieval , Humanos , Itália , Morte Perinatal , Gravidez , Trepanação/mortalidade
4.
Neurocirugia (Astur) ; 28(1): 28-40, 2017.
Artigo em Espanhol | MEDLINE | ID: mdl-27208912

RESUMO

A review is presented on cranial trepanations performed by primitive cultures. The scientific interest in this topic began after the discovery in 1965 by Ephraim G. Squier of a pre-Columbian trepanated skull, and studied by Paul Broca in Paris. Pseudotrepanation and other types of cranial manipulation are reviewed. The techniques, technology, and instruments for every type of trepanation are well known. There are a surprisingly high percentage of cases showing signs of post-trepanation survival. Indications for trepanation are speculative, perhaps magic. Although trepanation in primitive cultures is widespread around the world, and throughout time, the main fields of interest are the Neolithic Period in Europe, the pre-Columbian Period in Andean South America, and some contemporaneous Pacific and African tribes. This particular trepanation procedure has no relationship with modern Neurosurgery, or with trepanations with therapeutic purposes performed since the Greco-Roman period in Europe, and afterwards around the world.


Assuntos
Medicina Tradicional/história , Trepanação/história , África , Antropologia Cultural , Remodelação Óssea , Comportamento Ritualístico , Traumatismos Craniocerebrais/cirurgia , Etnicidade/história , Europa (Continente) , Fósseis , Cefaleia/cirurgia , História do Século XVI , História do Século XIX , História do Século XX , História do Século XXI , História Antiga , Humanos , Imageamento Tridimensional , Oceania , Osteogênese , Peru , Crânio/diagnóstico por imagem , Crânio/patologia , Crânio/cirurgia , Tomografia Computadorizada por Raios X , Trepanação/instrumentação , Trepanação/métodos , Trepanação/mortalidade , Cicatrização
5.
J Neurol Surg A Cent Eur Neurosurg ; 77(5): 416-21, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27123748

RESUMO

Objective To compare the results of the use of irrigation versus no irrigation during burr hole evacuation of chronic subdural hematoma (CSDH). Methodology The study was a retrospective chart review of those patients who underwent burr hole evacuation of CSDH during a period of 5 years. Cases were divided into two groups based on the use of irrigation during surgery. A subdural drain was placed in all patients (i.e., in both the irrigation and no-irrigation groups) and removed 24 to 48 hours postoperatively. Results The total sample size was 56, of which 34 patients were in the irrigation group and 22 in the no-irrigation group. Recurrence rate was 17.6% in the irrigation group and 9.1% in the no-irrigation group (p = 0.46). Systemic complications were predominantly cardiac related in the no-irrigation group compared with respiratory complications in the irrigation group. The irrigation group had a mortality rate of 5.9% compared with 4.5% in the no-irrigation group (p = 0.66). Conclusion No statistically significant difference was found between the two groups in terms of recurrence or mortality.


Assuntos
Hematoma Subdural Crônico/cirurgia , Irrigação Terapêutica , Trepanação/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Hematoma Subdural Crônico/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Trepanação/mortalidade
6.
Arq Neuropsiquiatr ; 54(1): 71-4, 1996 Mar.
Artigo em Português | MEDLINE | ID: mdl-8736148

RESUMO

Thirty five patients with chronic subdural hematoma were treated surgically between 1988 and 1995. The patients, aged 19 to 80 years, were graded retrospectively according to the Bender scale. The clots were removed via burr-holes with irrigation of the subdural space to ensure as complete an evacuation of subdural collection, and craniotomy with membranectomy. The mortality rate was 16.6% with craniotomy and 0% with burr-hole. The patients who died, 80% were in grade III or IV. The pathogenesis and surgical treatment of chronic subdural hematoma has been controversial, and still remains obscure.


Assuntos
Hematoma Subdural/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Craniotomia/mortalidade , Drenagem/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Trepanação/mortalidade
7.
Arq. neuropsiquiatr ; 54(1): 71-4, mar. 1996. tab
Artigo em Português | LILACS | ID: lil-164057

RESUMO

Os autores relatam 35 casos com diagnóstico de hematoma subdural crônico, operados no período de janeiro-1988 a março-1995. A idade dos pacientes variou entre 19 e 80 anos. Foram eles agrupados retrospectivamente segundo a escala de Bender. Quanto ao tratamento cirúrgico, foram empregadas duas técnicas: craniotomia com membranectomia e dupla trepanaçao com instilaçao de soluçao salina na cavidade ocupada pelo hematoma. O índice de mortalidade entre os pacientes submetidos à craniotomia foi 16,6 por cento e nos pacientes submetidos à trepanaçao foi nulo. Dentre os pacientes que faleceram, 80 por cento encontravam-se em grau III ou IV na escala de Bender. O hematoma subdural crônico apresenta até os dias atuais alguns aspectos controversos, como quanto à sua fisiopatologia e ao tratamento cirúrgico adequado.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Hematoma Subdural/cirurgia , Idoso de 80 Anos ou mais , Doença Crônica , Craniotomia/mortalidade , Drenagem/mortalidade , Tomografia Computadorizada por Raios X , Trepanação/mortalidade
8.
Neurologia ; 6(7): 247-50, 1991.
Artigo em Espanhol | MEDLINE | ID: mdl-1768443

RESUMO

Several clinical variables from a series of 101 patients with acute subdural hematoma (ASDH) operated on during the period 1979-1989 were compared with those from another group of 43 patients who were operated on during the period 1987-1989. Twenty-seven patients (26.7%) in the earlier period and 15 (34.8%) in the later one were younger than 40 years. The difference was not significant. There was a higher proportion of patients, 41 (40.5%), in the earlier period (1979-1982) who had traffic accidents than in the 1987-1989 period, where trauma was the mechanism in 15 patients (38.8%). However, the difference was not significant. Seven patients (6.9%) from the earlier group and 18 (41.9%) from the later group had a lucid interval. This difference was significant (p less than 0.001). During the 1979-1982 period 80 patients (79.2%) were comatose on admission as compared with 27 (62.7%) during 1987-1989. The difference was significant (p less than 0.05). A small group of 11 patients (10.8%) from the earlier series were operated on by means of craniotomy or trephine; by contrast, this approach was used in 35 (81.3%) patients from the later series. The difference was significant (p less than 0.001). Seventy-nine (78.2%) and 26 (60.4%) patients died in the periods 1979-1982 and 1987-1989, respectively. The difference between the mortality rates of both groups were significant (p less than 0.05). Our data suggest that the earlier diagnosis and the use of wider surgical procedures have contributed to the reduction in mortality.


Assuntos
Hematoma Subdural/mortalidade , Acidentes de Trânsito , Doença Aguda , Coma/etiologia , Traumatismos Craniocerebrais/complicações , Craniotomia/mortalidade , Drenagem , Serviços Médicos de Emergência/organização & administração , Hematoma Subdural/diagnóstico por imagem , Hematoma Subdural/etiologia , Hematoma Subdural/cirurgia , Humanos , Estudos Prospectivos , Estudos Retrospectivos , Espanha/epidemiologia , Tomografia Computadorizada por Raios X , Trepanação/mortalidade
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...