RESUMEN
Intraoperative monitoring of cerebral blood flow (CBF) has become an invaluable adjunct to vascular and oncological neurosurgery, reducing the risk of postoperative morbidity and mortality. Several technologies have been developed during the last two decades, including laser-based techniques, videomicroscopy, intraoperative MRI, indocyanine green angiography, and thermography. Although these technologies have been thoroughly studied and clinically applied outside the operative room, current practice lacks an optimal technology that perfectly fits the workflow within the neurosurgical operative room. The different available technologies have specific strengths but suffer several drawbacks, mainly including limited spatial and/or temporal resolution. An optimal CBF monitoring technology should meet particular criteria for intraoperative use: excellent spatial and temporal resolution, integration in the operative workflow, real-time quantitative monitoring, ease of use, and non-contact technique. We here review the main contemporary technologies for intraoperative CBF monitoring and their current and potential future applications in neurosurgery.
Asunto(s)
Neurocirugia , Circulación Cerebrovascular/fisiología , Humanos , Monitoreo Intraoperatorio/métodos , Procedimientos Neuroquirúrgicos/métodos , TecnologíaRESUMEN
Nutritional rickets remains a significant public health issue for children worldwide. Although it has almost disappeared in industrialized countries following routine vitamin D supplementation, recent evidence suggests an increasing incidence, especially in young children. In addition to the classical clinical consequences on bone and the growth plate, rickets may also be associated with life-threatening neurological and cardiac complications in the most severe forms. Consequently, early screening and treatment are required. Here, we report the case of a 2-year-old child who presented with severe nutritional rickets associated with seizure and cardiomyopathy. Family screening revealed rickets in all the siblings. This case report emphasizes the importance of being aware of this disease, notably in population with sociocultural risk factors.
Asunto(s)
Conservadores de la Densidad Ósea/administración & dosificación , Gluconato de Calcio/administración & dosificación , Colecalciferol/administración & dosificación , Raquitismo/tratamiento farmacológico , Raquitismo/etiología , Cardiomiopatías/complicaciones , Preescolar , Humanos , Masculino , Raquitismo/complicaciones , Raquitismo/diagnóstico , Convulsiones/complicaciones , Resultado del TratamientoRESUMEN
OBJECTIVE: The natural history of pineal cysts still remains unclear. Incidental pineal cysts have become more common which raises the question of their management. Symptomatic pineal cysts may require a surgical solution but therapeutic indications have not yet been clearly established. METHOD: From 1986 to 2012, 26 patients with pineal cysts were identified. Their medical records were retrospectively assessed focusing on the initial symptoms, imaging characteristics of the cyst, management strategy, operative technique and their complications, as well as the latest follow-up. A systematic review of the literature is also presented. RESULTS: Twenty-six patients with pineal cysts were identified. The mean age was 23.5 years ranging from 7 to 49 years. Symptoms included intracranial hypertension with obstructive hydrocephalus in 18 cases and oculomotor anomalies in 12 cases. Two adult cases presented with non-specific headaches and did not require surgery. Twenty patients were operated via a suboccipital transtentorial approach with total removal of the cyst in 70% of the cases, while the remaining 4 cases were treated with an intraventricular endoscopic marsupialization associating a third ventriculostomy. Four patients required a preoperative ventriculo-peritoneal shunt due to life-threatening obstructive hydrocephalus. Overall, peri-operative mortality was nil. In the two non-operated patients, the cyst remained stable and no recurrences were observed in all operated patients with a mean follow-up of 144 months. CONCLUSION: In the majority of incidental pineal cysts, a clinical and imaging follow-up is sufficient but occasionally not required especially in adults as very rare cases of increase in size have been reported.
Asunto(s)
Neoplasias Encefálicas/cirugía , Quistes del Sistema Nervioso Central/cirugía , Hidrocefalia/cirugía , Recurrencia Local de Neoplasia/cirugía , Derivación Ventriculoperitoneal , Humanos , Derivación Ventriculoperitoneal/métodos , Ventriculostomía/métodosRESUMEN
PURPOSE: The efficacy of overnight wear of four types of reverse-geometry lenses was compared. The length of time needed to achieve correction and any adverse events that occurred during the course of the study were recorded. METHODS: In this prospective, randomized study, 60 subjects (18 to 35 years old) with refractive error between -1.00 to -4.00 D (cyl = -1.50) wore reverse-geometry lenses overnight only. All subjects were assigned a Rinehart Reeves lens in one eye, and subsets of 20 subjects were randomly assigned a Mountford BE, DreimLens, or Contex D Series 4 lens for the contralateral eye. Visits included baseline, dispensing, 1 day, 1 week, and 1 month. Biomicroscopy, unaided visual acuity, subjective refraction, best-corrected visual acuity at high and low contrast and high and low illumination, corneal topography, and subjective rating data were collected. RESULTS: Forty-six subjects completed the study. At 1 month, there were no significant differences between lens types in their effect on unaided visual acuity, subjective sphere, subjective cylinder, best-corrected visual acuity at high and low contrast at high illumination and low contrast at low illumination, apical corneal radius, corneal eccentricity, and subjective ratings. Between 1 week and 1 month, there was a significant improvement in subjective ratings of quality of day and night vision (p < 0.05) but no significant change in the objective measures. No significant ocular adverse events were observed during the trial. CONCLUSIONS: The lens types tested were all similarly effective in the reduction of myopic refractive error. Subjective ratings continued to improve after objective measures stabilized at 1 week. Overnight lens wear proceeded for 1 month without significant adverse reactions.